Improvement of risk factor management amongst hypertensive patients by educating family practitioners: the israeli blood pressure control (IBPC) program

Abstract

The IBPC program was designed to improve risk factor control amongst hypertensive patients, without allocating patient treatment to specialized risk factor clinics. The program started in August 2000, and it was headed by authoritative figures in risk factor control in Israel. Family practitioners, each caring for 1000 to 5000 patients, were asked to join the program and register data of hypertensive patients. Each physician was allocated a small budget for program related expenses. The organizing committee scheduled meetings every 2 months, to report on the progress of the program, and to review the treatment guidelines. Each physician received the data analysis concerning his clinic, and a comparison to the other centers. After one year, the participants filled the follow-up data regarding the same patients. A total of 4742 patients from 30 centers were recruited for the registry. After 1 year, systolic and diastolic BP dropped by 5.2% (from 142±16 mmHg to 135±14 mmHg, p<0.001, and from 85±11 to 80±8 mmHg p<0.001 respectively). 46.5% had controlled BP (according JNC VI) at follow-up compared to 31.6% at baseline (p<0.001). 88% of the clinics had more patients reach the JNC VI goals than they did at baseline, and 78% had more than 35% of their patients achieve the goals (compared to 30% at baseline, p<0.001). LDL-c reduced from 134±35 mg/dL at baseline to 126±49 mg/dL (p<0.001) at follow-up, and 42.6% had LDL-c levels below the ATP-III recommended goals(compared to 31.5% at baseline, p<0.001). 94% of the clinics had more patients reach the ATP III goals than they did at baseline, and 66.6% pf the clinics had more than 35% of their patients achieve the goals (compared to 33% at baseline, p<0.001). The changes in blood pressure and lipid levels were achieved by enhancing adherence to perscribed treatment, increasing the number and dosage of BP and lipid lowering medications and improving lifestyle. The estimated 10-year risk according to ATP 3 risk charts was reduced from 18.0 (6% 10-year risk) to 17.4 points (5% 10-year risk) in females (p<0.001) and from 16.9 points (25-30% 10-year risk) to 13.8 points (12-16% 10-year risk) in males (p<0.001). We demonstrated that a physician education program can improve the quality of treatment in high risk patients in the community.