New Oversight Put in Place for Physicians Giving Anemia Drugs to Patients With Cancer

tension guidelines, to develop a hypertension disease management plan consistent with JNC guidelines, and to achieve blood pressure control. While the CDC has yet to determine why guideline adherence is poor, George Bakris, MD, president-elect of the American Society of Hypertension, said some reasons are obvious. “There is a general lack of willingness to increase doses for patients with an asymptomatic disease, especially when the patients are telling you that theydonotwant thedrugs,” said Bakris, who is also professor of medicine and the director of the University of Chicago Medical Center’s hypertension center. “This kind of communication takes time. But because reimbursement for such discussions is so low, it forces physicians to see a lot of patients in a short period of time, and the discussion is cut short.” Vincenza Snow, MD, director of clinical programs and quality of care for the American College of Physicians (ACP), said physicians are aware of the guidelines, but they sometimes fail to bring that knowledge to the patient encounter. “Physicians have trouble implementing the guidelines because of competing priorities, patients with multiple comorbidities, or visits for acute problems where planned chronic care gets pushed back to the end of the visit.” And while acknowledging a certain lack of adherence to guidelines, Snow added that ACP data suggest adherence rates may be artificially low due to measurement methods. “When you are told that 70% of blood pressure levels in your practice are not at target, you have to remember that many times the denominator used to get that 70% is all the patients associated with your practice who haveacode forhypertension,”Snowsaid. “But some of these patients have never come to your practice—they were assigned to your practice by an insurance company and never make an appointment—and some may come in for 1 visit and never return.” Snow said the ACP has implemented programstoimproveadherenceforthose patients who are truly under treatment by a physician. “What we have learned from our quality improvement program is that we train teams,” Snow said. “You have to change your systems to help yousucceed.Youneedtogetothermembersofyour teaminvolved; for example, maybe someone on your staff is very interested in patient education.”