Hypertension management in primary care: how effective is a telephone recall for patients with low appointment adherence in a practice setting?

Abstract

Studies showed a positive association between appointment adherence and blood pressure control. In randomized-controlled trials blood pressure therapy was improved by recall systems. We analyze the effectiveness of an active telephone recall on blood pressure control for patients with low appointment adherence in regular primary care. This retrospective cohort study analyses all hypertensive patients without any hypertension-related disease (primary prevention) of an academic teaching primary care practice using a structured hypertension management. Blood pressure levels at the beginning of the hypertension management and after 1 year were analyzed. Blood pressure control rates (<140/90mmHg) and average blood pressure of patients with good appointment adherence and those requiring a phone recall were compared. A total of 410 hypertensive patients were identified. A telephone recall was required in 22% (n=92), which was successful in 87% of patients (n=80). At the beginning, 66% of appointment adherent patients had controlled hypertension which increased to 81% after 1 year. In patients not adhering to appointments the initial blood pressure control rate was 59% and improved to 74% after 1 year. Average blood pressure office readings decreased from 141/90 to 136/86mmHg (p<0.05) in those adhering to appointments, while it improved from 146/92 to 138/88mmHg (p<0.05) in those requiring recall. Active telephone recall improved blood pressure control of hypertensive patients with low appointment adherence in regular primary care. An active recall can be recommended for other primary care scenarios.