Abstract
Objective: Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control.Design and setting: Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region.Patients: A total of 88,945 patients with uncomplicated hypertension age 40–79.Main outcome measures: Odds ratio (OR) for the individual patient to achieve the BP target of ≤140/90 mmHg.Results: Overall, 63% of patients had BP ≤ 140/90 mmHg (48% BP < 140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32).Conclusions: In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.
Highlights
Quality is, depending on the area of interest, difficult or impossible to define and measure
STATISTICAL METHODS The primary care centres (PCCs) visit pattern was characterised by PCC mean number of appointments with nurses and physicians respectively and breakdown of facilities into two groups depending on the ratio between appointments to the two professions
The impact on entries in VGR after the introduction of payment linked to diagnoses boosted entry of chronic conditions, which qualify for higher reimbursement than minor health problems [96]
Summary
Quality is, depending on the area of interest, difficult or impossible to define and measure. This thesis does not attempt to evaluate quality of primary care as a whole, only a few important aspects after a national reform in Sweden 2009. The reform was accompanied by a search for indicators to monitor and analyse the performance of primary care centres. This thesis deals with quantitatively important areas in which relevant results can be directly translated to clinical practice. Options for following up primary care at the regional level have increased in Sweden, partly as a result of a national reform in 2009. In Region Västra Götaland (VGR) this was the starting point for a quality initiative with about 100 indicators, using extensive healthcare registers
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