In a recent IDT meeting for a Program for All Inclusive Care for the Elderly (PACE), we discussed the advantages of self-monitoring of BP in the home setting. We now have guidelines from multiple organizations that recommend home BP measurements as superior to those done in clinics or institutional settings. The SPRINT trial of 2014 and now multiple other studies have confirmed that reliable BP measurements require:

1. Appropriate positioning of the patient
2. Correct positioning of a right-size BP cuff
3. A relaxed and quiet environment for at least 5 minutes
4. Discarding the first BP because of the “Startle” effect (may elevate the BP)
5. Checking another two BPs and recording their average readings as the patients’ BP

This process takes about 7 minutes, which is too time-consuming for most clinics and institutional settings. In my experience, patients are very willing to follow these recommendations, but are seldom aware of them and tend to follow what they have seen modeled in our institutions. Patient education handouts on this subject may improve the quality of home BP measurements with the goal of safely reducing their SBP into the 120 range thereby reducing their risk for stroke and cognitive impairment without increasing their risk for falls or syncope. Other studies have shown this is true even for our older and frail clients.

In our PACE program, we believe empowering our participants and caregivers to optimize their self-care occurs when we share well-done patient education handouts. I have attached a one-page pictorial education piece created by JAMA that teaches patients the correct way to take their BP. JAMA has created a library of such one-page pieces on multiple topics with helpful pictures that help patients understand what they could do to support their future health. Some of the chronic medical problems of our older patients could benefit from better in-the-moment self-care. In the PACE program we provide supportive care for these choices and align them with each patient’s health care goals.

Besides JAMA, there are multiple other sources of good free patient education materials, which may be more appropriate for some patients than those created by JAMA. I like the ones created by UpToDate for patients who want basic or beyond-the-basic information. For preventive care education, I like those created by AGS Health in Aging Foundation.

For our PACE program with the help of our IT specialist, I have installed a link to each of these patent education libraries that are visible in the top toolbar when I login to the EHR system. This means I can quickly find an appropriate article for a patient when I am using the exam room computer and print it, so it is available at checkout. At the same time, I can document this action in our EHR so the rest of our team can support this self-care activity.

I realize that PACE programs have an ongoing interdisciplinary team approach that may not be feasible for a skilled facility’s post-acute rehab patient, but I still wonder if we would have better outcomes if patients, caregivers, and families were better educated in areas where supported self-care could improve their quality of life and reduce their risk for future health complications.

Is it time for your facility to provide appropriate patient education handouts?

References:
JAMA Home BP Measurement Handout: https://jamanetwork.com/journals/jama/fullarticle/2643764
JAMA Patient Information Handouts: https://jamanetwork.com/collections/6258/patient-information
UpToDate Patient Education: https://www.uptodate.com/contents/search?search=Patient%20Education
AGS Health In Aging Patient Education: https://www.uptodate.com/contents/search?search=Patient%20Education