Description

Hypertension is one of the most common causes of sickness and premature death in the adult population. The MedeSure Hypertension A&M Package will change this outcome within 1 year, and represents one of, if not the best investment in health, future quality of life, and length of life that an individual with hypertension could make.

Mechanism of Organ Damage by Hypertension

Persistently elevated blood pressure (hypertension) causes gradual thickening of the walls of the heart, which pumps blood against this pressure, and of the blood vessels which have to withstand this pressure. The increased thickening occurs mostly on the inside causing narrowing of the blood vessel passage (lumen) and the chambers of the heart. The thin, inner lining of the blood vessels is also damaged by high pressures causing formation of plaques (corrosion), which further narrows the lumen. This effect is intensified in the tiny blood vessel branches within the organs. The result is gradual decline in blood flow to the organs, with progressive decline in organ function and eventual organ failure. These are inevitable consequences of persistently elevated blood pressure. The heart, kidneys and brain are the most commonly affected, with angina (chest pain), heart attacks or heart failure, kidney failure, strokes or dementia.

The heart is particularly susceptible because not only does the walls of the heart (muscles) thicken and the chambers pump less blood, but the small blood vessels that supply fresh blood to the heart muscles and run on the surface of the heart (coronaries) are also narrowed. So the thickened heart which pumps faster as it is pumping less blood with each contraction, and needs more fresh blood (oxygen), gets less because the coronaries are narrowed. This causes sudden heart damage (heart attack) or sudden death if a narrowed coronary gets clogged by a blood clot or ruptured plaque, or gradual failure of the heart occurs as the muscle deteriorates with thinning, weakness, enlargement of the heart, irregular beats and eventual premature death.

All these changes occur silently over 5 – 20 years, depending on the severity of the blood pressure elevation and the presence of other factors such as increased body weight, decreased activity levels, high cholesterol levels, uncontrolled diabetes, smoking and stress, and there are no symptoms until an organ has become impaired. Impairment of an organ may be halted or its decline may be slowed, but are not reversible. It means therefore that hypertension, which begins in young healthy adults, 20 years and older, must be identified and controlled early to ensure good quality of life and long life.

How the Hypertension A&M Package works

The MedeSure Hypertension A&M Package has three main objectives (1) to assess all the organs affected by hypertension, (2) outline a management plan for each affected organ, and (3) obtain blood pressure control within 1 year. The diagnostic tests and disease management protocols are the most current and state-of-the-art available, utilizing an electronic medical records system to which all the providers of services have secure online access. The MedeSure member also has secure online access to his/her medical records through a Patient Portal.

The initial encounter with the MedeSure primary care physician will involve a complete medical history and physical examination utilizing protocols that ensure a complete evaluation, and an initial assessment is provided to the member. Written referrals to diagnostic facilities for the diagnostic tests in the package will be provided, as well as for any other condition the physician may consider important. The reason for each referral will be discussed individually. A medical management plan for hypertension will be developed by the physician, and may include medications from the MedeSure Medication Formulary, which are the most efficacious and cost-effective medications available.

The member will be contacted by the MedeSure Nurse Advisor for feedback on the initial physician encounter, and after each subsequent office visit, to discuss the medication(s), including dosing, possible side effects, drug interactions, provide additional information, answer questions, arrange appointments for each diagnostic test/facility and provide specific preparation instructions for each test or procedure when necessary. The member may also call the Nurse Advisor at any time with questions or concerns. The results of laboratory tests, the effectiveness and side effects of each medication, and any other medical concern will be assessed and discussed by the physician on each office visit, and changes and adjustments in the treatment plan will be made accordingly. Each new recommendation will be assessed for effectiveness on the subsequent office visit. Follow up office visits will be scheduled within 2 – 3 months but may be sooner as circumstances dictate.

After 1 year upon completion of the package, a Continuing Care Document will be provided which will include all the medical documentation accumulated over the period. and recommendations for continuing medical care. The member may continue their medical care with the MedeSure physician, or the Continuing Care Document may be provided to any medical provider for continuing medical care.

Product Description

• Complete physical examination,
• Urinalysis,
• CBC, Chem Pac,
• ECG,
• CHEST X RAY,
• 4 additional Doctor’s visits.
• 12 monthly supplies of 2 oral antihypertensive agents from the Medesure formulary. (Price not included in Package price)

The Hypertension A&M Package provides a complete physical examination, urine test, a comprehensive laboratory test, ECG and chest X ray. A comprehensive laboratory test will provide information about the condition of the blood cells and conditions such as anemia, leukemias and myeloma, electrolytes in the blood stream like sodium and chloride (salt), potassium, and the function of the liver and kidneys.

The comprehensive laboratory tests – CBC, Chem Pac – seek to identify abnormalities of the blood cells, blood chemistry, blood glucose, lipid panel, kidney function, liver function. Additional tests, not covered by this package, may be recommended by your MedeSure Participating Physician for further evaluate abnormalities.

Uncontrolled hypertension causes damage to the kidneys which cause the leakage of substances into the urine which are identified on a chemical urine evaluation (urinalysis).

An electrocardiogram or ECG test records the electric current that causes the heart to beat as it passes through the heart. When there is a blockage of any of the very small branches of blood vessels carrying blood to the heart, there is some damage to the heart that often does not cause any symptoms and are not noticed during regular activities. The electric current does not flow normally through the damaged portions of the heart, and even small, damaged patches can be picked up on the ECG test.

A chest X ray provides information about the size of the heart and its chambers, and provides information about whether hypertension has caused enlargement of the heart with secondary effects on the lungs. Many conditions that may involve the lungs and not cause respiratory symptoms in the early stages, may also be detected. This includes cancer of the lungs, which may be cured, if identified in the early stages.

Follow up office visits are brief visits for a status assessment for blood pressure measurement, review and discussion of laboratory data, to ensure compliance with medications, evaluation of medication side effects or adverse reactions, and medication dosage adjustments, additions or discontinuations.

Medications are prescribed from the Medesure Medication Formulary and are dispensed from Participating Pharmacies. Medications will be supplied monthly, at the beginning of each month. The choice of medications is the decision of the doctor and patient.

Payment Terms

Initial downpayment of 50% of the Package price, which may be made in 2 instalments, is required and the remainder is due in 3 months. The price of this Package does not include medications.  Payments for medications must be received by Medesure Jamaica monthly, 2 weeks in advance of delivery.