Educational Webinar: Strategies to Help Improve Patient Monitoring Workflows in Extended Care

Operator: Hello, and welcome to McKesson Medical Surgical's educational webinar series. We are pleased to present today's webinar. It is entitled Hypertension and Blood Pressure Management with Baxter. Please take a moment to review our legal disclaimers regarding this webinar and to submit questions for our speaker. Please locate the Q&A panel in the lower left corner of your console. Our expert will answer your questions this time allows at the end of the presentation any questions that we're not able to get to. We'll certainly reach out to you following the presentation. Today's presentation will be recorded and available as a replay within a few days of the webinar, so watch your inbox for that. We're excited to welcome today's presenter, Zachary Clark. Zach is the marketing manager for Baxter, leading the primary care space for the Welch Allen patient monitoring portfolio. For over a decade, he's worked with healthcare organizations of all sizes to optimize processes and standardized techniques. He holds degrees from both St. Bonaventure University and Syracuse University. Thank you so much for joining us today, Zach. We're pleased to have you with us. the floor is now yours. Zachary Clark: All right, well, thank you so much and thank you to everyone who is able to join us today. And what a way to put a bow on Heart month here with our topic around hypertension and the importance of proper blood pressure measurement. And as Brandon mentioned, my name is Zach Clark. I work for Baxter, and I'm really excited to be able to present this topic to you that I hope you find educational. And also, it's something near and dear to my heart pun intended that I hope we can have a little bit of fun today, but also some education around hypertension in this topic of blood pressure. Now, before I go too far, you kind of saw Baxter there. You heard the word Welch Allyn. All these different names, logos, brands, and I just always want to clear this up anytime for my audiences, is that Welch channel and Baxter are actually now part of one team. And how that came together is back in June of 2015, Hillrom purchased the Welch Channel brand, and then a couple years ago, in December of 2021, Baxter purchased Hillrom. So vis-a-vis Welch channel is now part of that Baxter family. So anytime you see any of these three names, just know we're all one big happy family and here to kind of support your needs as you go along. But I'm actually located here in our skinny Atlas Falls facility, our headquarters for our well channel product line. And so as Brandon mentioned, I hope as we go along here that you input any questions that you have, and we can take care of those at the end. So if we dive in now into our topic, and really my first question is around why blood pressure is so vital. And that's because studies say that higher systolic blood pressures and diastolic blood pressure numbers are associated with increased risk of all these things that you can see on my screen here. Cardiovascular disease, MRIs, heart failure, stroke peripheral artery disease, even abdominal, aortic aneurysms. So all these different things can happen to us when we have those increased numbers for our blood pressure. And if we looked at that same study it actually said when somebody has 20 millimeters of mercury higher for their systolic score and 10 points higher for their diastolic score, it's actually associated with doubling. And yes, the real number is doubling. The risk of death from stroke heart disease and other vascular diseases. So as you can see the blood pressure sometimes it's a measurement that we take for granted, right? A patient walks in, we should be taking a blood pressure on everybody. and sometimes it's a check the box moment that we have, but in reality, it's actually a vital measurement for us to be looking at the overall health wellbeing of our patients. And really the importance of the blood pressure measurement dates back to you know, obviously a long time ago, but there was a higher focus on this with what was called the sprint study or short force systolic Blood Pressure Intervention trial. And that really started back in 2012 when they had a large panel of participants around 10,000 people who got their blood pressure measured over the course of a year. And the goal of this trial was to better understand how treating high blood pressure to a target systolic score of less than 120 was better than treating to a goal of 140. So, 140 being kind of that target goal that folks had at the time. What this study had over the course of two and a half years when they looked at these numbers, was that in adults age, 50 and older who had high blood pressure and at least one additional cardiovascular disease risk factor. But they had no other history of, say, diabetes or stroke. You can see the numbers here, 25% had a reduced rate of high blood pressure complications, such as a heart attack, heart failure, and stroke. And 27% of those participants had a lower risk of death. Very significant numbers and very significant statistics that caught the eye of some of our governing bodies that we have. And that really led to these updated guidelines that we have from 2017. From the American College of Cardiology and American Heart Association which they titled the guideline for the prevention detection, evaluation and Management of high Blood Pressure in Adults. These were the original guidelines that they set out. They later updated them in 2019, but this was a significant large update as it was really the first update that the medical community had on hypertension since 2003. And so what these guidelines did was it gave a whole host of different information that we could have around things like non-pharmacological interventions patient evaluation treatment of high blood pressure, strategies to improve hypertension treatment and control, and really the overall plan of care for hypertension. So not only did it go into when to prescribe medications and how that should function, but also how we should be assessing and measuring blood pressure on our patients hence where we are today. Within these guidelines that they had; it really updated the hypertension thresholds that we had. So what we had before as you can see here in the chart, was anybody was considered a normal blood pressure if they had less than 120, and their diastolic score was less than 180. Now, there was this category called pre-hypertension, where it was 120 to 1 39, so almost a it's a 19-point band there. The diastolic range was 80 to 89, and then that's where it moved into things like stage one hypertension and stage two hypertension before we got into a hypertensive crisis. Now, in 2017, what happened was we updated these guidelines now to be just a little bit different. So normal blood pressure that category stayed the same, but instead of pre-hypertensive, now we had elevated, and the point band is much smaller, 120 to 1 29. Stage one hypertension at 130 to 139, stage two at 140 or higher, and then hypertensive crisis at 180. And so I'll kind of get out of the way here. And so I, I always like to highlight what stage one hypertension was. So beforehand, we were really targeting that score of 140 before someone was considered hypertensive. And we lowered that number now to 130, and that's a direct result of what the sprint trial was statistically telling those governing bodies that we should really shoot for those lower scores. This is also a nationwide issue that we have. And so the chart that I have over here when the original numbers came out in 2017 right before that 2016, it was believed that about 32% of the US or adults in the US I should say, had hypertension. Almost one in three of us. But once we updated those thresholds that you just saw, it came out to about 46% of the country now had hypertension, 46% of those adults. And the latest numbers that we ran that we have access to, we're now up to 48. 1% of adults have hypertension. And you can see on the map here, I mentioned it as a nationwide issue, and these are the death rates associated with hypertension. The darker color of reds being a little bit more of an issue than the lighter colors. But as you can see all across the country here we have adults are struggling with hypertension and actually ultimately dying because of it. Now, it might be interesting to know that there's actually different types of hypertension that we have. And not really just talking about stage one and stage two, the first one that we have is called sustained hypertension. And so of that 48. 1% of the population, it's believed that 77. 5% of them have that term sustained hypertension. And what this really means is we have high blood pressure all the time, whether it's in the doctor's office, whether it's at home whether it's me here presenting, I'm sure my BP's skyrocketing right now. But you have that high blood pressure all the time. And then there's this category called white coat hypertension, or some folks might call this white coat syndrome. And that happens in up to 35% of the patient population. And what this is, is it's those patients who walk into a doctor's office, they get their blood pressure but they have heightened anxiety or stress levels inside where they see those, "White coats. " So their blood pressure shoots up, meaning they have a higher score inside the office than they would just at home outside of it. And then there's this category called mass hypertension. So that's up to 26% of our population has this, and it's the exact opposite of what you would think white coat is. So mast is, I have a normal blood pressure inside the office but maybe I have stressors at home or at work where I have a higher blood pressure. And so that would mean I mast. So we have these different types of hypertension, and really what it led us to is asking this question around how could we impact hypertension if we made a decrease in our nation's systolic blood pressure score by just five millimeters of mercury? And so, we actually took that theory, took that question, and we looked at the same dataset or the publicly available dataset that the AHA does when determining their numbers. And what we found was when you reduce that systolic score by just five millimeters of mercury, you can actually reduce your hypertension rate from an age adjusted standpoint by 16. 3%. So just a small drop in that systolic score could make a significant impact on the patient population that you have. And so, obviously, where can those five points come from. There's without a doubt, lifestyle changes that folks can make. Our patients can do a bevy of things to be able to reduce that, those five points. But for us, it also comes down to how we can improve the accuracy and properly measure our patient's blood pressure. And that's really where the rest of this presentation is going to really lean on and go from a talk track standpoint, is how can we improve this accuracy and improve how we're measuring blood pressure? For us, that comes down to the 3Ts. And so the first there is all about technique. And so following recommended guidelines for accurate blood pressure measurement. The second t being around time, so averaging several readings together with rest periods in between, and then repeating that over two to three office visits. And then the third T being around tools using automated blood pressure devices for in-office measurements per our AHA and ACC recommendations that we just saw. And so, when we can combine these 3Ts we look at it from a perspective of first and foremost, how can we help our patients with this? And then second from a clinical practice standpoint, how can we be better clinically, operationally, and then financially from a business perspective? So before we go into the first T technique, I love this quote. It's use a couple different studies but it reads, "Even though BP measurement is considered a routine, relatively easy task, measurement errors are common and can lead to misleading categorization of an individual's true BP. " And I kind of mentioned it at the top, that sometimes we take blood pressure readings for granted. We're whoever's taking them, I put that cuff on, I get that blood pressure, I'm checking the box, I'm getting their temperature of their SPO2, I'm moving on to my next person. But really as we can see in some of those numbers that we had, it's so important to the patient's overall health. And honestly, sometimes, even though we look at it as something that's easy, there's common errors that come along with it. And I'll show you why here. But from a tips perspective that the AHA tells us and this is directly from those 2017 guidelines, we should really have our patients be seated for three to five minutes first without talking or moving before recruiting, or excuse me, recording our first BP reading. And I'm, I'm sure you can count I have both hands both set of hands, both set of feet, how many times people come in, they're running, they're late for an appointment maybe even a little sweaty because they're just trying to get there and you're taking the blood pressure on without them really getting a chance to settle down. And then second there, the patient should really avoid caffeine, exercise and smoking for at least 30 minutes before measurement. And obviously this is not in our control if in a clinician's control to be able to do that. But trying to give those guidelines out for patients because these are obviously all stimulants that could affect somebody's blood pressure and raise it higher. But the AMA also gave out this great graphic as part of their MAP BP program. And it's seven simple steps to getting get an accurate blood pressure reading. And so on purpose, I've hidden the seven steps, and I'll go through them one by one here. But what the A MA did was they mapped out the seven steps for the accurate BP, but then if we don't follow those steps how could, how it could affect our patient's blood pressure. And so the first one is all about using correct cuff size. So if we use a cuff size too small, that could add anywhere from two to 10 millimeters of mercury to our patient's score. And I actually have some more information in a minute on why cuff size is so important. The second thing here is putting cuff on a bare arm the cuff over clothing that could add anywhere from five to 50 millimeters of mercury just based on how thick that the clothing is. And I always joke that this happens to me, and I was actually just an hour beforehand talking to a coworker in the hallways here, and she went and got her blood pressure taken and it was 170 but the technician had taken it over her sweatshirt. And so when they rechecked it, they put it over her bare arm. She was in a much more albeit elevated range but the blood pressure was much lower. So really being able to focus on that. The third item here is supporting arms at heart level. So if it's unsupported that could add 10 points there. Something we don't always think about. But keeping your legs on cross, that could add anywhere from two to eight points, supporting your back and feet unsupported. That could add another six points. And this is would be particularly common if you have patient exam rooms where you don't really have a chair or a place for somebody to sit and they're just kind of propped up on an exam table. And then the next one here, being an empty bladder, a full bladder could add up to 10 points there. And then not having conversation. So talking or active listening could add up to 10 points to a patient score. And the conversation one, that's an interesting perspective, because if you're currently using a manual blood pressure device, it's almost like an unspoken bond between the patient and the clinician that when they're having the cuff, they're listening that it's an active activity inside the office. I really shouldn't talk that person's concentrating. but what we've noticed though, is with some digital blood pressure device users who are recently switching over, it's almost like they think that the device is doing all the work for them, which in some ways it is, in many ways it's not. But having a conversation sometimes creeps up a little bit more. So having these steps to getting that accurate BP is incredibly important. Then this is from the AMA. It's not just me saying it, and you're probably raising your hand saying, "Yeah, but Zach, I mean, how often do these things really actually happen? " Well, there are other studies about this of how often these events don't occur. And so from a cuff size perspective, 48% of the time we're using the wrong cuff size for our patients, which is a staggering number. So being able to kind of switch that out and not just using what's on the hose is important there. 41% of the time, we don't put the cuff on a bare arm. 75%, this is extremely high. Three out of four patients, their arm's not supported at heart level. 20% of the time, somebody's legs are crossed. 65% of the time, another high number here, back and feet aren't supported. Couldn't find a statistic on empty bladder. I don't think anybody would want to admit to that. And then 40% of the time we're having a conversation during our blood pressure. So these things are more common than we often think. And if we look at our goal, where are we going to find those five points of reducing our systolic scores? This is oftentimes the first place that we look at with anybody taking a blood pressure, are you filing the proper technique in order to get that best score that you can? Now, I mentioned cuff size and cuff size really does matter. So you saw the numbers of a cuff size is too small, could add points. How often we're not using the correct cuff size. But there was a study that was recently pub published around cuff size and how often someone is diagnosed with hypertension. And so when someone is using a cuff size too small, 39% of the time, they are actually misclassified as being hypertensive. And if someone is using a cuff size too large, 22% of the time, they are missed as being hypertensive. So just having that proper cuff to measure around the patient's arm circumference to make sure they're getting the best measurement for themselves obviously has a big factor on whether we diagnose somebody as hypertensive. So really, again, focusing on having the proper cuff sizes within the office and using them with your patients can actually play a significant role even in just a hypersensitive diagnosis. So that was our first T technique. Now, our second T is all about time, and for us that means blood pressure averaging. And so if you're not familiar with what blood pressure averaging is, it's the process of taking two or more readings and then averaging them together. So an obvious de definition once you see it and how this could work out from an example standpoint is, let's say I have a patient, and we're going to do three readings on them. So our first reading here is 133 over 82. If we just took this one, technically this person is on their way to being stage one hypertensive. But now because we're doing averaging, our second reading was 127 over 79, our third reading 123 over 76, and then our average reading now is 128 over 79. So as you can see, the patient as we went along in this example, had time to settle down, and they ultimately ended up with an average blood pressure of 128 over 79. So it's still elevated, but an elevated blood pressure would obviously change our treatment plan than if we had a blood pressure in that 133 over 82. And so when we look at the numbers of this and the variability between blood pressure measurements that we have, the fact is 95% of manual blood pressure users, they only take one reading. So if you think about your own practices that you have, or even personal appointments that you've been in more than likely you're only taking one BP reading. And if you're a digital user, this number only slightly dips down to 90%. But the fact is, though, 41% of the time, our patients have a higher first reading. So not only are we taking just one measurement, but then we're leaving a significant portion of our patients do have a higher first reading than what would be in a subsequent reading. And speaking of variability, there could be anywhere from a 10-point variation between each reading. And so that kind of played out in the example that we had those 10 points, but then you can kind of if we think back again, to, "Okay, where are we going to find the five points to reduce our systolic readings? " BP averaging is another way that we could possibly achieve that. Sticking on a topic of variability, there was also a study done showing how patients could or could not receive the proper care. And so when we looked at this study and someone said, "Hey, if I only use the first blood pressure that I took, that one reading, 27% of my patients there would've received improper care. " And how that breaks down is 13% of the patients would've not gotten the appropriate management and follow ups that they needed. And then 14% of patients would've been managed more aggressively than needed. So underdiagnosed and no overdiagnosed just based on that one measurement. Now this comes straight from our American Heart Association and ACC guidelines that we have. And so I love this statement around the use of a validated AOBP device that can be programmed to take an average, at least three BP readings should be considered the preferred approach for evaluating office BP. To ensure that the patient and staff member are not talking during the measurement unattended AOBP may be preferred over attended A OBP. So it's the AHA actually saying to us that we should be considering doing the blood pressure averaging. It's the method that we should look at. And again, that actually derives from the sprint study that I mentioned just a little bit ago because the sprint study to get the final measurements that they had actually used the BP averaging technique. So I'll highlight a couple sections here. I just mentioned it, the three BP readings. but the one that always confuses people and throws them off a little bit is around this unattended AOBP. And you're probably thinking, well, how do you take blood pressure if a clinician's not in the room? How does that actually work, and why is this really there? So the reason why it's there is, again, because of that white coat hypertensive effect when somebody's in there, they see that clinician, they get all nervous, their blood pressure might go up. But if it's unattended, they'll be sitting in the room alone, have a chance to calm down, and then maybe you'll get a bit more of an accurate reflection of what their blood pressure is. How this is achieved is that some devices on the markets today you can actually do what's almost like a delay to start kind of feature where you select button, it might count down from anywhere from 1, 10, 15 minutes or so just depending on what you have. And then the device can go through and start that protocol. And so what happens is the patient can be there, they can have their time alone to get their blood pressure, and then the clinician can go off and do some other clinical activity or in busier office settings, maybe just have a second to catch their breath. And so these are the guidelines that we have direct from the AHA on this. And so that's two of our Ts down. So we talked about technique, we talked about time, and now our third T here is all about tools. And those are to help measure an accurate blood pressure. And again, this is the last time I'll read directly from the guidelines. But in the office setting, the use of the oscillometric device provides an approach to obtain a valid BP measurement that may reduce the human error associated with oscillatory measurements. So asymmetric, that's our digital BP devices oscillatory, meaning those manual. And again, I'll just highlight one section here around the fact of may reduce the human error. And so that's kind of the theme of these next few slides here. So, human error that could come in many factors, whether that's the poor technique that we may have saw or could refer to this phenomenon called terminal digit preference. And this is when a blood pressure reading ends in its zero. And so I have some statistics on how often this happens. And it's really 32. 8% of the time a manual blood pressure reading is taken, it ends in a zero. And surprisingly, when an automated blood pressure device is used, those readings only ended at zero, 12. 4% of the time. That's just statistics. There's bound to be some zeros in that number. But the fact that this is twice as high of a percentage kind of leads you to, "Okay, what does that mean? " So, terminal digit preference, this is really referring to when somebody says, "Hey, the score is 122 over 78, well, that's 120 over 80. That's close enough. And in that situation, sure, it could seem harmless, right? But that's still inaccurate. Where this becomes really dangerous is when somebody to say, "Hey, it's they're 128 over say 84. " Well, all of a sudden they're one 30 over 85, and they're now in a hypertensive range. And you might be thinking, "Hey, my staff would never do this. They're properly trained, they've got all the right technique down. " But we asked this very question to one of the largest clinical groups out on the West coast. they came to us, they were asking us for some advice and some devices to be able to try out digital blood pressure within their clinics. And so they had 20 MAs that were taking blood pressures and the leading doctor on the project when she came to us, she specifically mentioned a few things about why they wanted to try digital BP. You know, one was the guidelines that we've all saw the second one was around white coat hypertension. She referred to it as white coat syndrome. So same thing. And then the third reason was she said, "Hey, we've noticed a lot of zeros on our numbers, and she called terminal digit preference out by name. " And so what we did was, before we started this trial, was we actually sent out a survey to all of those MAs and we had a couple other questions, but asked specifically, "Hey, how often do you round up or down your blood pressure numbers before you enter them into the EMR. Out of the 20? Only one of them admitted to you know, rounding their numbers. So, although it, it might seem like, "Hey, my staff would never do this. " But coming from the doctor who said, "Hey, I noticed a lot of zeros. This is a pattern even I'm seeing and only one person admitting it. " It could just raise, raise a flag for others there as well. And from a digital BP device perspective, there's also some studies that say manual blood pressure may actually just be higher than what is taken with an automated device. So some of these studies when looked at manual versus automated, the average automated score was 14. 3 points lower on the systolic end, and four points lower on the diastolic end. Again, coming back to our theme, where we're going to find those five points between technique, time, and tools, these are all things here. And then there's also the time element of it. So other studies suggest that automated blood pressure devices can allow for multiple BP readings and using programmed algorithms to immediately interpret an average BP reading to correlate with an awake ambulatory BP reading in one third of the time needed to take those same readings manually. And really how that statistic works is the average, or I shouldn't say the average, but some devices can take a digital BP reading 49% faster than you can manually. And how those numbers would then add up over the course of average blood pressures to get you to that one third number. So if you are doing BP reading or BP averaging, or even if you're taking one reading there is a time element and an efficiency standpoint that many folks see with a digital BP device. And then there's also EMR connectivity with this. And that's number one around reducing transcription errors. But then there's also MIPS measurements with this. And so this is the 2003 MIPS measurement, but I checked right before this the 2004 measurement is also exactly the same. And this is around controlling high blood pressure. And so how this is measured there's a really legalese statement around it. But the layman's terms of it is anybody between 18 and 85 who doesn't have or who receives an essential diagnosis of hypertension, which according to this MIPS guideline is 140 over 90, within six months, they need a validated reading below that number. I could come in, have a higher score than 140 over 90, and as long as I come back into the office and you could sit there and take 20 blood pressures on me until I get a score lower, then I would count towards that percentage of patients who are now "Controlled blood pressure. " And where this comes into play with a digital BP device we were talking a little bit about the accuracy there, but also from a reporting standpoint. So you want to make sure within your EMR and your data is as accurate as possible. And so when you have all the data going in accurately, and let's just say, "Hey, my score was 126 over 81 but somebody typed it in as 162. " And all of a sudden, "Hey, this person wasn't flagged. They're not supposed to be flagged for hypertension, but all of a sudden, they are. " And so if you can reduce those transcription errors, you can reduce what you're seeing here from accuracy of your data standpoint. And then there's also just the reporting function of it as well. We've talked to certain value-based care organizations, and they always say the most efficient, the fastest, and the most organized organizations are always sending us data directly from their EMR that they get from their devices to be able to accurately represent the percentages that they have in their patient population. So again, coming down to our hypothesis. Reducing five points. It could reduce our hypertensive population by 16. 3%. But what I'd like to do now is actually take a look at how this can become real from a numbers perspective. And so I'm actually going to come over to a whiteboard that I have here in the studio and demonstrate what that really means. I'll just make sure I have my right pen here. And so let's just take, for example, if we had one provider. So we've got one provider in our office. Now, the average provider, give or take, they're going to see about 1300 patients a year. The this figure that we're going to go with is 1306. And that's just from the studies that we follow. But again, give or take, you might have a different number. Now, if we looked at the hypertensive population that we have. Again, that's going to come down to our 48. 1% number, and that's going to lead us to 628 patients within our pool of folks that have hypertension. Now, if we reduce this number by 16. 3%, what we're going to end up with is taking out 102 of these patients giving us a new number of 626, or excuse me, 526 patients. Thank God there's an eraser on this thing. So we have our new number, 526 patients. Now, where that gets interesting is, "Okay, I see those 1300 patients a year. My average interaction with a provider is 17. 4 minutes. " Now, if you take our 17. 4 minutes and our now reduction of 102 patients, what we're going to see is from a time perspective, 30 hours of time savings over the course of a year. And so that's just one provider within your practice. So if we reduced this number here by the 16. 3%, and we kind of follow the trail of the math here, that's 30 hours per year that a clinician could save within their office. Now, what you do with the 30 hours, that's kind of up to a clinician. Do they give more time back to their staff? Do they use that time to see new patients for new revenue? There's a bevy of different options that you could have for your 30 hours. But that's really how the math works out. And hopefully my camera kind of comes back into focus here for everybody. Now, to recap as we kind of come to the end here as I mentioned, there's clinical, operational and financial impacts that we can all have from accurately measuring our blood pressure. From a clinical perspective, reducing the hypertensive population by the 16. 3% number that we had, and then also reducing the bias from under or overtreating our patients. Operationally, we can take blood pressure readings in one third of the time if we're using BP averaging, or again, 49% faster with digital devices. And then automated protocols can allow us to do unattended BP readings, which again, would follow those AHA ACC guidelines, but also be a little bit more efficient for our staff to go do other clinical activities. And then from a financial perspective, time is obviously money. So what can we do with an extra 30 hours per year per clinician with within our office? Now, I have a challenge for all of you here on the phone, or it's really four challenges that I hope you can all walk away with. And that first one is you know, really harp on and reinforce proper technique with anyone taking blood pressure measurements in your office. If you Google AMA MAP, BP, proper technique that graphic that I showed, that'll pop up and even if you print them out, have them in your office, following those seven simple steps and really making sure that folks are taking blood pressure the right way is not only going to be significant for your patient population but also if you're par participating in those value-based care models. Number two, really be conscious of white coat hypertension. Kind of recognize the signs of that and use techniques to be able to help mitigate that within your patient population. Whether that's giving patients time to rest doing unattended bps or some other strategy that you have to be able to kind of combat this white coat hypertension. Number three is check your recorded blood pressure readings for terminal digit pattern. So you heard me talk about it, so now it's going to be in your subconscious. You can't get away from it. But if you just kind of go through and actually make a concerted effort to audit those readings to see if there's a pattern that you're noticing within your own practices, it's just something that's always good to be aware of again, from a proper training standpoint with your staff. And then number four, we have a phrase on here of just try it. So if you're a manual VP user now just give automated vitals a chance, and if you already have a digital vitals machine just try things like BP averaging. How can you do some different techniques that might be able to help your patients? With that, that is all the scheduled content that I have. And from a legalese standpoint, I'll show some of the references that we have. But at this point, I'll be able to kind of take any questions that we have coming up in the chat and we'll give a second for those to come in. Operator: Thank you so much, Zach. Just as a reminder for everybody, you can submit your questions in that Q&A box down in the bottom left hand of your screen. We did have a couple come in during the presentation which I can go ahead and pass those along to you. Zach, when you're taking a blood pressure reading, does it matter left or right arm? Zachary Clark: I have so many clinical in the room, so I'm just looking at her. I don't believe left or right is really going to matter when you're taking your blood pressure. So really from a perspective left or right, it really wouldn't matter for us. As long as if you're doing an SPO2 reading, we just recommend doing your SPO2 reading on the opposite arm that you're taking your blood pressure. Great question, though. Operator: Excellent. You mentioned some slides back when you were talking about doing the multiple readings, the three readings. Does recommended time that between those readings? Zachary Clark: Yeah, that's a great question as well. So the sprint study that was referenced, they waited about a minute in between each reading but the guidelines say anywhere between 30 seconds and a minute is kind of the recommended number there. Operator: Do you have any opinions regarding automated wrist blood pressure readings? Zachary Clark: It really just comes down to the accuracy in which the manufacturer of the wrist blood pressure device is claiming. So for us, it's always about meaning there's an organizational body. There's a few of them around accuracy. The one that we most point to is A-A-M-I. And so as long as the device is meeting some of those AAMI standards around accuracy, then BP averaging is really the way to go. From a personal preference, we're always kind of preferential to radial arm readings but I know wrist devices have become popular. So it's really all about kind of the accuracy standards that the manufacturer of those devices is setting. Operator: Could you maybe give us some, some techniques for auditing blood pressure measure measurements for terminal digit preference? Zachary Clark: Yeah, that's a fantastic question. The one that I like to always suggest is if you do have all of the data in an EMR, even if your devices aren't connected or anything, and you've got clinicians typing those numbers in, there should be a way to export those numbers into some kind of spreadsheet. And the most visual way to do it is if you just get all those numbers and then you put them on a horizontal bar graph. And so when you do that, you'll be able to see kind of from 100 to 200 kind of how the bar stack up. And from a visual perspective, you'll be able to land on things like 110, 120, 130, 140, 150 as the bars kind of spike up as you go. That's one technique from a visual perspective that I recommend. Operator: We've had someone ask for, let's see, is can you give us any detail or reasoning behind a high systolic number and a normal diastolic number or vice versa? Zachary Clark: That's a great question. Honestly, I wouldn't feel comfortable answering. I wouldn't really know the right answer to tell you on that one. But that's a great question, and I can actually take that and ask some of our clinical folks that we have at the company and share that with the McKesson team to share out with everybody. Operator: Certainly. There was a follow up for talking about the waiting time between checks. Is that for automated or manual blood pressure checks? Zachary Clark: So that's for both. So you know, waiting in between blood pressure checks, it comes down to a couple factors. So there's the BP averaging factor of it. So taking those two or three measurements, waiting a minute in between and getting that average score. But then when someone is determined to have stage one or stage two hypertension within the guidelines, the AHA and ACC give us there's a really great neat chart in there around how often they should come back in to be rechecked. And so, the average visits, it's usually about three visits to kind of be able to go through and be able to diagnose someone as hypertensive. But then there's also a home BP component of that as well. Going to either having someone buy a home blood pressure monitor or supplying them with one to take their blood pressures in the home setting as well. But the AHA and the ACC have a great chart on how often you should come in. Operator: Excellent. Let's see, I had a question here. Are there any age groups that have higher rates of hypertension as opposed to other groups? Zachary Clark: Yeah, that's a great question. So really the age rates it goes a little bit of a hockey stick as you get older. As you kind of progress into 40s, 50 60, 70 eighties, and you know, kind of into that 65 plus population is where you're more prone to have high blood pressure according to the statistics. If you looked at the graph, it is really one of those kind of things that move up. And that's why some of those numbers that we saw around 48% of the population having hypertension, all those things will be age adjusted to account for the fact that more folks within the higher age brackets will have hypertension. Great question. Operator: And thank you everyone. So we've got a steady stream of questions coming in is great. So for hypertension, patients that are wanting to check their blood pressure at home, should they be checking at the same time of day for consistency? And do you have recommendations for which device to use? Zachary Clark: Yes. So anytime you're checking your blood pressure, you should actually be checking it multiple times a day if you are doing it at home. So it's usually anywhere from three to five times and that's right when you're awake sometime in between during the day, usually around dinner time, and then also before you go to bed just so you can get a full range of the scores that you have during those different times of day. And that can correlate to other different stressors that might be happening in the patient's life. Then as far as devices that we recommend so I do work for a device manufacturer. Our well channel devices. So we do have home blood pressure monitors that above all, I would recommend those. Operator: Excellent. We've seen a lot of buzz in the news and all about GLP-1 drugs for weight loss. Do they have any effect on blood pressure? Zachary Clark: That's a good question. honestly not something that I've read up on, so I can't really speak confidently about that. But that, that's obviously a topic that we'd love to take a look, look at more. Operator: Excellent. Okay. I'll lead just another minute or so for questions to come in. While we're doing that. we'll direct your attention to the wall there behind Zach. Just another look at our disclaimer and the contact number for our resource team. Again, check your email in another day or so, you should be receiving a recording of this presentation. And we'll make slides available to you. Of course, if you have any additional questions, you can reach out to us here at McKesson at any time. We invite you to continue learning with us at mms. mckesson. com/educational webinars where you can register for upcoming events, see our schedule and then of course, be whitelisted for other event notifications and things like that. Just a heads up, we are preparing a new website. So would, if anything on there is out of date fear not you should receive emails with notifications for upcoming events until we launch in another couple of weeks. So Zachary, thank you so much for your time today. I really appreciate it. If you have time for one more question, just came in under the wire, how often do we recheck the patient's blood pressure? Zachary Clark: How often? Really as often as you deem clinically necessary? So from a just a clinical perspective you know, if you recheck somebody's blood pressure two or three times within an office visit, sometimes that's completely normal. Again, most people will only check it once. But really, it's kind of up to your clinical guidelines that you have there. So it wouldn't be use your best judgment from a patient safety standpoint. Operator: Sure. Excellent. Well, with that Zach, I thank you for your time today. I really appreciate it and all of our audience as well. Thank you so much for joining us this afternoon. Zachary Clark: Yes, great. Thank you all so much. I really enjoyed this, and I hope you got as much out of it as I did. So thank you so much and take care.