Physician Adherence to Blood Pressure Guidelines and Its Effect on Seniors

Milchak, Jessica L.; Carter, Barry L.; Ardery, Gail; Dawson, Jeffrey D.; Harmston, Matt T.; Franciscus, Carrie L.

doi:10.1592/phco.28.7.843

Cited by 27 publications

(21 citation statements)

References 31 publications

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“…The primary aim was to evaluate if guideline adherence improved more in the intervention group than the control group, using a tool validated for this study 21–23. Once the patient completed the trial, the research nurses performed a structured medical record abstraction process for all patients that included all clinic progress notes, laboratory values, medications and records from hospitalizations or emergency department visits.…”

Section: Methodsmentioning

confidence: 99%

Physician and Pharmacist Collaboration to Improve Blood Pressure Control

Carter

Ardery²,

Dawson³

et al. 2009

Arch Intern Med

275

392

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Background Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The purpose of this study was to evaluate the effectiveness of a physician/pharmacist intervention to improve BP control. Methods This was a prospective, cluster-randomized controlled clinical trial with clinics randomized to control (n=3) or intervention (n=3) groups. The study enrolled 402 patients with uncontrolled hypertension (mean age 58.3 years). Clinical pharmacists made drug-therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Results Guideline adherence scores increased from 49.4 ± 19.3 at baseline to 53.4 ± 18.1 at 6 months (9% increase) in the control group and from 40.4 ± 22.6 to 62.8 ± 13.5 (57% increase) in the intervention group (p=0.089 adjusted comparison between groups). Mean BP decreased 6.8/4.5 and 20.7/9.7 mm Hg in the control and intervention groups, respectively, (p<0.05 for between-group systolic BP (SBP) comparison). The adjusted difference in SBP was −12.0 (95% CI: −24.0, 0.0) mm Hg, while the difference in diastolic BP (DBP) was −1.8 (CI: −11.9, 8.3). The 24-hour BP levels showed similar effect sizes. BP was controlled in 29.9% of patients in the control group and 63.9% in the intervention group (adjusted odds ratio 3.2; CI: 2.0, 5.1; p<0.001). Conclusions A physician/pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates when compared to a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management.

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Section: Methodsmentioning

confidence: 99%

Physician and Pharmacist Collaboration to Improve Blood Pressure Control

Carter

Ardery²,

Dawson³

et al. 2009

Arch Intern Med

275

392

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“…9 Given the low rate of adherence, it is not surprising that only 30 to 60% of patients are at goal blood pressure. 4,6,[10][11][12][13] These data come from studies that evaluated hypertensive management in the outpatient setting. No study has evaluated adherence to hypertension guidelines or blood pressure control rates among nursing home residents.…”

Section: Introductionmentioning

confidence: 99%

“…14 Evaluating adherence in this high-risk group is also important because the elderly may be less likely to receive guideline-adherent care. 13 The goal of this study was to evaluate adherence to JNC VII guidelines among nursing home residents.…”

Section: Introductionmentioning

confidence: 99%

Hypertension Guideline Adherence Among Nursing Home Patients

et al. 2009

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BACKGROUND: Adherence to hypertension guidelines in the outpatient setting is low. OBJECTIVE:To evaluate adherence to JNC VII guidelines in nursing home patients.DESIGN: Data were obtained from the 2004 National Nursing Home Survey (NNHS), a nationally representative sample of US nursing homes. Patients with hypertension were identified using ICD-9 codes. Adherence to JNC VII guidelines was defined as the use of a thiazide diuretic in patients without a compelling indication for a different class of antihypertensive medication, such as diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke.PARTICIPANTS: There were 13,507 patients in the 2004 NNHS survey, of whom 7,129 had hypertension.MAIN RESULTS: Of these 7,129 hypertensive patients, only 12.6% were on a thiazide. Out of the 7,129 hypertensive patients, 3,113 did not have diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke. Of these 3,113 patients, only 13.9% were on a thiazide. After excluding patients with a potential contraindication to a diuretic, such as hospice care or incontinence, only 18% were prescribed a thiazide. Of the 3,113 patients, 1,148 were on a single class of antihypertensive and more were prescribed a beta blocker, ACE inhibitor, calcium channel blocker, loop diuretic, and ARB than a thiazide diuretic.CONCLUSIONS: Adherence to hypertension guidelines among nursing home patients is low. The appropriate use of thiazide diuretics could reduce costs and improve blood pressure control and patient outcomes.

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“…It has been demonstrated that nondelayed treatment could prevent 14% of strokes and 20% of major cardiovascular events in 5 years [71]. More generally, physicians' adherence to BP guidelines is poor when patients are over 65 years of age [72]. Older patients with isolated systolic hypertension may particularly be undertreated, because many general practitioners tend to consider their BP acceptable even if systolic BP is 140 mmHg or higher, provided that diastolic BP is less than 90 mmHg [73][74][75].…”

Section: Review Casiglia Tikhonoff and Pessinamentioning

confidence: 99%

Hypertension in the elderly and the very old

Casíglia¹,

Tikhonoff

Pessina

2009

Expert Review of Cardiovascular Therapy

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High systolic blood pressure represents a challenge for the modern world. Epidemiologists are in the best position to appreciate the importance of systolic hypertension and its cardiovascular consequences. Although the label of hypertension seems to have lower importance in the elderly, and above all in the very old, than in younger people, high systolic and high pulse pressure are risk factors for cardiovascular events and necessitates treatment. Unfortunately, due to indolence and lack of aggressiveness, only a limited fraction of elderly hypertensive patients receives adequate therapy.

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Physician Adherence to Blood Pressure Guidelines and Its Effect on Seniors

Cited by 27 publications

References 31 publications

Physician and Pharmacist Collaboration to Improve Blood Pressure Control

Physician and Pharmacist Collaboration to Improve Blood Pressure Control

Hypertension Guideline Adherence Among Nursing Home Patients

Hypertension in the elderly and the very old

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