AHA Quality: Educating Patients and Providers Boosts BP Control

By John Gever
BALTIMORE, 05 may 2008-- More patients were able to control their hypertension after an education program targeting both patients and healthcare providers, a researcher said here.
Note that this study was published as an abstract and presented as a poster at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
In two Veterans Affairs hospitals and nine clinics where the program was implemented, the percentage of patients achieving their target blood pressure levels increased to 64.3%, versus 61.8% at baseline (P<0.0001), reported Christianne L. Roumie, M.D., M.P.H., of the VA Tennessee Valley Healthcare System in Nashville.
With 53,936 patients under treatment at these facilities during the study, the improvement translated into 1,349 additional people achieving blood pressure control, Dr. Roumie said in an interview prior to her presentation at the American Heart Association's Conference on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.
She noted that hypertension is the most common chronic condition among patients treated in the VA health system.
The program had four components:
Standardizing blood pressure measurement procedures using a protocol to increase accuracy and improve documentation
Educating patients about achieving and maintaining adequate control
Developing and distributing pocket cards and posters for providers outlining VA-sanctioned treatment algorithms
Developing a review process for individual providers' and institutions' performance relative to program goals.
Patients' blood pressure measurements were obtained from the VA health system records.
Baseline data on 28,620 patients were collected for the 21 weeks before implementation of the program. The program's effectiveness was determined from data collected over 18 weeks, on the basis of 25,316 patients' last recorded blood pressure measurement.
Adequate control was defined as systolic pressure less than 140 mm Hg and diastolic pressure less than 90 mm Hg.
Dr. Roumie said there was wide variation among the participating facilities in how well the program worked.
One of the hospitals had an absolute improvement in the prevalence of adequate control from baseline of 2.8 percentage points (63.5% before versus 66.3% after, P=0.001), whereas the other hospital showed no improvement at all (59.9% before versus 59.7% after).
She said most of the team members who developed the program were based at the first hospital. "They may have had more ownership of the program," she said.
Only one of the team members worked at the second hospital, where more than 7,000 patients were treated, and other staff there were less enthusiastic about the program, Dr. Roumie said.
She said there was also significant variability in the success of the program among the nine outpatient clinics.
"One had a huge improvement, more than 7 percentage points," she said.
The prevalence of blood pressure control at the outpatient clinics overall increased 1.9 percentage points (61.9% before versus 63.7% after, P=0.053).
Dr. Roumie said the experience in this effort, as well as previous published research, indicates that dedicated and enthusiastic leaders are needed to make such programs work.
"You need champions of your cause," she said.
She said improvements of two or three percentage points are clinically important, given that hypertension is so common.
She also noted that these percentage points were gained at relatively little monetary cost.
No external funding was reported. No potential conflicts of interest were reported.
Primary source: AHA Quality of Care and Outcomes ConferenceSource reference:Not available until May 27