Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol

Egan, Brent M.; Sutherland, Susan E.; Rakotz, Michael; Yang, Jianing; Hanlin, R. Bruce; Davis, Robert A.; Wozniak, Gregory

doi:10.1161/hypertensionaha.118.11558

Cited by 59 publications

(61 citation statements)

References 27 publications

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“…The main cause of false TI was physicians’ concerns about the BP measured in the clinic being inaccurate, which is consistent with the reports of previous studies. 8 , 9 HT treatment should be designed as a framework for physicians to improve the outcome of HT care and reduce TI. 9 However, appropriated TI should be more accurate if patients are encouraged to use SMBP at home, as the present study revealed that this is the second greatest cause of false TI.…”

Section: Discussionmentioning

confidence: 99%

“… 8 , 9 HT treatment should be designed as a framework for physicians to improve the outcome of HT care and reduce TI. 9 However, appropriated TI should be more accurate if patients are encouraged to use SMBP at home, as the present study revealed that this is the second greatest cause of false TI. Furthermore, current clinical guidelines indicate that SMBP is effective in lowering BP.…”

Section: Discussionmentioning

confidence: 99%

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Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand

Sornsenee¹,

Vichitkunakorn²,

Choomalee³

et al. 2021

RMHP

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Introduction Hypertension (HT) has a significant impact on health care worldwide. Therapeutic inertia (TI) is defined as the failure to intensify therapy in the absence of an optimal goal and is widely used as a quality of care parameter. The coronavirus disease 2019 (COVID-19) pandemic has affected many health-care systems, including HT care. Therefore, the present study assessed the impact of the COVID-19 pandemic on TI and its predictors in patients with HT. Methods The electronic medical records of patients with HT who attended a primary care clinic at a tertiary hospital during pre-COVID-19 (February 2019 to February 2020) and COVID-19 (March to August 2020) periods were reviewed. Results Our study included 6089 visits during the 12-month pre-COVID-19 period and 2852 visits during the 6-month COVID-19 period. Most of the baseline characteristics of the HT patients were not significantly different between the two time periods. During the COVID-19 period, the percentage of uncontrolled HT visits decreased from 43% to 31%. Similarly, the prevalence of TI decreased from 81% to 77%. False TI was predominantly due to physicians’ concerns regarding the in-clinic blood pressure measurement being inaccurate during both the periods. Conclusion After readjustment for the physicians ‘reasons, the true TI was 64% and 60% in the pre-COVID-19 and COVID-19 period. For adjusted physician and patient-related factors, multilevel modeling was used. Senior medical staff visits, elderly patients, prior diabetes mellitus diagnosis, patients who used more than one type of anti-HT medication, and patients with systolic blood pressure >150 mmHg were all predictors of TI. The COVID-19 period, on the other hand had no effect on TI with an adjusted odds ratio of 0.82 (95% confidence interval, 0.67–1.01).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand

Sornsenee¹,

Vichitkunakorn²,

Choomalee³

et al. 2021

RMHP

View full text Add to dashboard Cite

show abstract

“…Variations in screening standards and policies have led to many patients who attend health facilities not having their blood pressure measured, many who have it measured not having it measured correctly, and many who have elevated readings not being diagnosed or treated for hypertension . Therapeutic inertia (not initiating or intensifying treatment despite elevated blood pressure) is a recognized problem, but diagnostic inertia is another, largely unrecognized, problem. Requiring ambulatory blood pressure monitoring is an additional potential cause of diagnostic inertia.…”

Section: Lessons Learnedmentioning

confidence: 99%

Scaling up effective treatment of hypertension—A pathfinder for universal health coverage

Frieden

Varghese²,

Kishore

et al. 2019

J of Clinical Hypertension

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High blood pressure is the world’s leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordination with the World Health Organization (WHO) and other partners. Better diagnosis, treatment, and continuity of care are all needed to improve control rates, and five necessary components have been recommended by RTSL, WHO and other partners as being essential for a successful hypertension control program. Several hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance. Improvement in hypertension management and control, along with elimination of artificial trans fat and reduction of dietary sodium consumption, will improve many aspects of primary care, contribute to goals for universal health coverage, and could save 100 million lives worldwide over the next 30 years.

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“…The few studies that report on such operational changes tend to be small (single setting) or lack the details necessary to be usable by and transferable to other primary care practices. [12][13][14][15] Even when operational changes are known, implementing them in busy primary care practices can be difficult. External support, such as providing practices with a facilitator to help foster change, is effective.…”

Section: Introductionmentioning

confidence: 99%

Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context

et al. 2021

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PURPOSE We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. METHODSWe purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in Evidence-NOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes. RESULTSIn clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health-or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health-and hospital systemowned practices that implemented these operational changes. CONCLUSIONS There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.

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Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol

Abstract: Supplemental Digital Content is available in the text.

Cited by 59 publications

References 27 publications

Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand

Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand

Scaling up effective treatment of hypertension—A pathfinder for universal health coverage

Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context

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