Abstract
BackgroundDifferent studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan.Methods and designDesign: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain). Sample: all patients with a diagnosis of hypertension (population based study). Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (α) will be set at < 0.05. Outcomes will be analysed on an intention-to-treat basis.DiscussionThe implementation of a quality improvement plan might benefit the coordination of different professionals of PHCTs and may also improve blood pressure control.Trial RegistrationThis protocol has been registered at clinicaltrials.gov with the ID number MS: 1998275938244441.
Highlights
Different studies have shown insufficient blood pressure (BP) control in hypertensive patients
The implementation of a quality improvement plan might benefit the coordination of different professionals of Primary Health Care Teams (PHCT) and may improve blood pressure control
Independent variables and effect modifiers The association of the following independent variables with the main dependent variable will be assessed: age, sex, treatment with antihypertensive drugs, number of antihypertensive drugs, co-morbidities, assessment of therapeutic compliance, health education, cardiovascular risk assessment according to the Framingham tables, duration of hypertension, and number of systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings within the past 12 months
Summary
Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. We decided to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. Hypertension is one of the most important risk factors of cardiovascular morbidity and mortality and one of the main reasons for seeking medical attention in primary care, especially in the elderly population [1,2,3,4,5]. In Spain, one out of two deaths of cardiovascular origin that occur yearly in patients above 50 years of age can be attributed to high blood pressure, and in 90% of cases to hypertension [6]. Treatment-related factors: it is becoming increasingly obvious that for many patients the use of monotherapy is not sufficient to control BP; other concomitant treatments the patient might be receiving can interfere with antihypertensive drugs; the specific antihypertensive drug chosen taking into account the degree of hypertension and the associated conditions
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