Wednesday, January 6, 2016

A better way to a healthier community, Part 2.

By: Anne-Laura Cook, MD, FACP, MHCM Medical Director, Population Health Management & Primary Care Innovation Baptist Health Centers

Five Modifiable Risk Factors to Prevent or Control Chronic Disease:

• Tobacco Use

• Diabetes and Prediabetes

• High Cholesterol

• High Blood Pressure

• Excess Weight and Physical Inactivity

In September, I wrote about two risk factors, Tobacco Use and Diabetes/Prediabetes. In this post, we will discuss the other three:

High Blood Pressure
High Cholesterol

Heart disease is the number one killer of women and men in the United States, and high blood pressure and high cholesterol are major risk factors for heart attack and stroke. Surveys show that more than 44 percent of Alabamians who have had their blood cholesterol checked were told that is was too high. More than 40 percent of adult Alabamians have been told they have high blood pressure (Source: BRFSS 2013).

Most people know that lifestyle changes – improving your diet, exercising more, losing weight, stopping smoking – can improve your blood pressure and cholesterol levels. However, making these changes often feels like an extremely difficult task. In Baptist Health System’s Be Well program, we help individuals set and keep attainable goals – using small steps of change to increase motivation and achieve big picture success over time. Through motivational interviewing, we determine an individual’s desire to change, confidence about change and readiness to change. We then create a plan, including setting specific self-management goals. We then monitor progress towards and address barriers to achieving these goals.

Although lifestyle change is emphasized, medications are often necessary in order to properly treat high blood pressure and high cholesterol, but medication only helps if you take it. Multiple studies have shown that approximately 50 percent of patients diagnosed with a chronic illness (including high blood pressure and high cholesterol) do not take medications as prescribed. In our Be Well program, we are proactive in addressing barriers to medication adherence. Understanding that financial barriers are one of the most common causes of lack of adherence, we assess and explain the out-of-pocket costs of medication on each employer’s health plan prior to prescribing a medication. At each visit, patients are asked to assess their degree of medication adherence and are encouraged to talk about the reasons why they struggle to take medication as prescribed. Is it an annoying side effect they associate with a particular medication? Do they always forget their morning dose because their medication isn’t strategically placed to remind them to take it each day? We tackle these hindrances to care in partnership with our patients, creating a plan that works well for each individual.

Excess Weight and Physical Inactivity

It is no secret that Alabama has a weight problem. According to recent data, 33.5 percent of adults in Alabama are obese (Source: RWJF, The state of obesity, 2015). Perhaps because this health problem is so pervasive in our community, we have come to accept excess weight as normal. That’s a problem for our long-term physical and economic health. It is estimated that obesity-related conditions costs more than $190 billion a year in medical spending in the United States (Source: Cawley J, Meyerhoefer C. The medical costs of obesity. Journal of Health Economics. 31(1):219-230. 2012.).

We know this issue is challenging from a big picture perspective, and it is challenging for the individual, too. Staring down a 50+ pound weight loss goal (or more) often seems like an insurmountable task. This is where small steps of change can have the greatest impact. Instead of focusing on an ideal weight goal, focus on the first five pounds. Rather than eliminating temptations from your diet, focus on cutting back unhealthy items or substituting healthier choices for a few servings of the foods or drinks that you know provide you with more calories than you need.

When we need to lose weight, we often put most of our focus on improving our diet; however, increasing our activity can have the greatest impact on health. Making small changes such as taking the stairs, parking at the far end of the parking lot, or taking a 10-minute walk break every two hours during the work day can make a tremendous difference in your metabolism, revving up your body’s ability to efficiently process the food that you eat. Asking friends or colleagues to join you in your activity can also bolster your confidence since you are accountable to someone else. We frequently find it easy to let ourselves down; it is harder to disappoint someone else.

Baptist Health System wants to change the way you think about your health. We want to prepare you to take better care of yourself and help you prevent chronic illness. We want you to spend more time doing the things that matter to you – we want you to Be Well.

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