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social workers, and other individuals. These health-care professionals work with
doctors, usually benefiting from care maps or algorithms to give care to patients
with hypertension. A significant element of this partnership is the upkeep of ordi-
nary follow-up, assuring guidelines are tracked, promoting patient self-manage-
ment, and founding defined linkages to specialist services and the health-care
infrastructure. In practice, when the hypertension is diagnosed, a clinic nurse may
take patient’s blood pressure regularly, arrange medications within preset parame-
ters, and assure that necessary testing is conducted. The family physician may
observe the patient periodically or in the event of difficulties that arise. If the pri-
mary care team faces difficulties in patient management, a specialist or specialty
team should be consulted. In this system, there is a change in the responsibility of
the specialist. First of all, the specialist may serve with their own multidisciplinary
team. Instead of seeing every patient, the specialists now observe only the more
complicated patients. While this may give way to more suitable use of specialist
talents, it may also pave the way for financial fines for the specialist. Another
responsibility of the specialist under the chronic care system is to help educate and
coach the primary care-based physicians and teams. By this way, specialists may
realize satellite clinics in primary care, communicate in academic detailing, ensue
group education sessions, or be ready for several distant consultation. In this altered
health-care system, extended evaluation and monitoring are predominant. Health-
care teams and regions are responsible for results. Indicator’s system is regularly
expanded, with feedback being displayed to respective physicians and to the system
in overall. For instance, a physician may submit an information on the number of
hypertensive patients at blood pressure objectives in his or her practice. Definitely,
the unnatural separation between diseases is eliminated, and the system endeavors
to cure the patient as a whole rather than the disease.
Information systems are important for enabling the changes as specified above.
An electronic central registry assures beneficial data to public health officers which
enable preventative or screening measures for hypertension to be aimed at high-risk
populations. A central registry also ensures information on disease load that sup-
ports in the planning and prediction of health-care services. Central registries are
entwined to other data repositories to ensure patient and physician reminders and
alerts. For instance, local disease management software may associate an accus-
tomed lipid level with the fact that a patient is hypertensive, reminding the physician
to start lipid-lowering therapy. Decision support installed in electronic schedules
can cater for similar support at primary care. Care to patients with hypertension and
other chronic diseases is generally compromised by the failure to share medical
information about patients. By this way, the medication record of a patient with
hypertension who alters physicians may not be fully recognized, potentially giving
way to adverse drug effects. The Western Health Information Collaborative project
is commonly financed by the federal government and four western regional govern-
ments. A significant aim of this project is to create data standards for chronic
disease that will ensure the sharing of core data between jurisdictions and care
providers [ 10 ]. Three main chronic diseases have been classified by the Western
Health Information Collaborative project: diabetes, chronic kidney disease, and
N. Keles et al.