Abstract
This 20-week quality improvement study describes implementation of a hypertension identification and management program with use of a standardized oscillometric blood pressure (BP) measurement protocol, provider education, and audit/feedback of hypertension control in a Veterans Affairs primary care clinic. A total of 692 male Veterans ages 18-85 years with treated hypertension and at least one clinic visit in the previous year were included for analysis. Mean age was 69.7 years (standard deviation 7.6) and race and ethnicity were 42.0% White, 29.1% Black and 3.0% Hispanic. Prior to program implementation, clinic BP was measured using the auscultatory method with a manual syphgmomanometer. Baseline BP measurements demonstrated bias as determined by terminal digit preference for digits 0 and 8 in 29.5% and 25.2% of systolic (SBP) and 31.6% and 21.8% of diastolic BP measurements, respectively (p < 0.001). Post-implementation of the standardized oscillometric BP measurement protocol, digit preference was eliminated. Protocol compliance was 89.1% at 5 weeks and 92.4% at 20 weeks. Overall average SBP was significantly higher in the post-implementation period compared to average SBP in the 12-month pre-implementation period (137.4 [Standard Deviation (SD) 17.4] vs. 126.3 [SD 15.3]; P < 0.001). Uncontrolled hypertension, (BP ≥ 140/90 mmHg), increased from 17.8% at baseline to 41.8% post-implementation while provider therapeutic inertia declined from 84.5% at baseline to 55.8% after 20 weeks. This study shows that terminal digit preference is reduced with implementation of standardized oscillatory BP measurement and a quality improvement program can reduce therapeutic inertia of hypertension treatment.
Highlights
AND BACKGROUND Treating hypertension remains one of the most important interventions for preventing cardiovascular disease and mortality [1, 2]
Future interventions for blood pressure (BP) control should consider these patient aligned clinical care team (PACT) resources to improve medication compliance and patient and caregiver partnership. This quality improvement pilot study based on MAP shows that a standardized BP measurement protocol can be implemented and sustained for at least 20 weeks in a VA PACT setting
● The MAP program has been shown to improve blood pressure control when implemented in underserved primary care clinics
Summary
AND BACKGROUND Treating hypertension remains one of the most important interventions for preventing cardiovascular disease and mortality [1, 2]. The hypertension improvement model endorsed by the AHA/ AMA, titled Measure Accurately, Act Rapidly and Partner with Patients (MAP), recommends AOBP for diagnosis and management of hypertension. The ACC/AHA guideline recommends a BP goal 10% and age 65–75 years old This ACC/AHA guideline recommendation was based on evidence that a lower BP goal in these populations reduces risk of stroke, coronary events, major cardiovascular events and cardiovascular mortality. For persons without these CVD risk criteria, the guideline recommends a BP goal
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
