Effect of Provider Education and Feedback on Antihypertensive Prescribing in a Department of Veterans Affairs Primary Care Clinic

Abstract

OBJECTIVE: This report summarizes a program to assess and modify antihypertensive prescribing in the primary care clinics of a Department of Veterans Affairs Medical Center. SETTING: The Ralph H. Johnson VAMC is a primary, secondary, and tertiary care medical center in Charleston, South Carolina. The primary care clinics that opened in August of 1995 consist of two multidisciplinary teams, with patient care coordinated by internal medicine providers in an ambulatory setting. INTERVENTION: The implementation of national treatment guidelines for hypertension. The treatment guidelines were presented and discussed with the primary care providers. Feedback information was presented monthly to providers about how their prescribing of antihypertensive medication related to the national treatment guidelines. MAIN OUTCOME: The program monitored for changes in prescribing patterns of antihypertensive agents after the implementation of national treatment guidelines. RESULTS: Six months after the implementation of national treatment guidelines for hypertension, prescribing of thiazide diuretic increased 11.5% and of angiotensin-converting enzyme inhibitors (ACEls) increased 4%, while calcium-channel antagonist prescribing decreased by 8.8%. One year after implementation, prescribing of thiazide diuretic continued to increase, up 23% from baseline, while calcium channel antagonist use decreased by 15%. ACEls again increased 4%. CONCLUSION: A structured program of provider education and feedback can significantly improve adherence to an implemented hypertension treatment guideline.