Use of Home Blood Pressure Results for Assessing the Quality of Care for Hypertension

JAMA ◽  
2018 ◽  
Vol 320 (17) ◽  
pp. 1753 ◽  
Author(s):  
Kevin O. Hwang ◽  
Eric J. Thomas ◽  
Laura A. Petersen
Keyword(s):  
Blood Pressure ◽  
Quality Of Care ◽  
Home Blood Pressure

P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Margozzini ◽  
A Passi ◽  
M Kruk ◽  
G Danaei
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Quality Of Care ◽  
National Health ◽  
Health Survey ◽  
Universal Coverage ◽  
National Health Survey ◽  
High Quality

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)

scholarly journals The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings

2020 ◽  
Vol 2020 ◽  
pp. 1-15 ◽  
Author(s):  
Sau Nga Fu ◽  
Man Chi Dao ◽  
Carlos King Ho Wong ◽  
Bernard Man Yung Cheung
Keyword(s):  
Blood Pressure ◽  
Health Literacy ◽  
Educational Level ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Limiting Factors ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
High Quality

Worldwide hypertension (HT) guidelines recommend use of home blood pressure monitoring (HBPM) in patients with persistent suboptimal blood pressure (BP) readings. It is not clear how patients with limited health literacy could perform HBPM to assist BP control. This study aimed at finding the association between HBPM and patients from lower socioeconomic classes, particularly on the effect of health literacy or educational level. Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for primary studies with keywords including educational level, health literacy, numeracy, home blood pressure monitoring, accuracy, and quality. The PRISMA guideline was followed. The quality of the literature was assessed by the Cochrane tool and modified Newcastle-Ottawa Scale. Nineteen interventional studies and 29 cross-sectional studies were included. Different populations used different cutoffs to report patients’ educational level, whereas health literacy was rarely measured. Three studies used psychometric validated tools to assess health literacy. The quality of HBPM could be assessed by the completion of the procedures’ checklist or the number of HBPM readings recorded. The association between subjects’ health literacy or educational level and the quality of HBPM was variable. The interventional studies showed that increasing professional-patient contact time could improve patients’ knowledge, efficacy, and quality of HBPM. Conclusion. Patients’ educational level and literacy were not the limiting factors to acquire high-quality HBPM. High-quality HBPM could be achieved by the structured educational intervention. The quality and amount of evidence on this topic are limited. Therefore, further studies are warranted.

Quality of Care in Patients with Type 2 Diabetes in Iran: A 5-year retrospective study

2019 ◽  
Author(s):  
yahya bayazidi ◽  
Majid Davari ◽  
Abbas Kebriaeezadeh ◽  
Bagher Larijani ◽  
Alireza Esteghamati ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Hemoglobin A1c ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional ◽  
Private And Public

Abstract Background The object of this study was to evaluate the quality of care indicators (process- and outcome-related) in patients with type 2 diabetes using patient-level data during the last 5 years in Iran, in private and public diabetes centers in five provinces (Tehran, Isfahan, Yazd, Mazandaran, and Kurdistan).Method Our study was a cross-sectional study carried out on patients with type 2 diabetes at 13 diabetes centers (private and public). Annual tests for hemoglobin A1C, serum lipid (LDL) and screening for nephropathy (urine protein or urine albumin quantitative test) were used to evaluate process-related and hemoglobin A1C, blood pressure and lipids levels were used to assess outcome-related outcomes.Findings Among 1976 patients, 54% were women with an average of 15 years of diabetes duration and approximately 83% of patients were obese or overweight. About 9% of patients had a hemoglobin A1C test every three months. The values obtained were favorable for controlling lipid profile but less than standard for screening for nephropathy and only about 30% of patients were within the optimal range for simultaneous control of process-related indicators. Findings for outcome- related indicators show that the achievement of blood glucose, blood pressure, and low-density lipoprotein targets were 31, 49 and 70%, respectively and concurrent achievement was 13.8% in the last year.Conclusion The performance of the health system has much room for improvement and diabetes control programs have not been favorable in any of the provinces studied and have not led to optimal control.

scholarly journals Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Cathy Kande ◽  
Robert Mash
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Blood Pressure Control ◽  
Catchment Area ◽  
Pressure Control ◽  
Prevalence Studies ◽  
Quality Of Primary Care

Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05) was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90) in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

scholarly journals Blood Pressure Control and Other Quality of Care Metrics for Patients with Obesity and Diabetes: A Population-Based Cohort Study

2018 ◽  
Vol 25 (4) ◽  
pp. 391-399
Author(s):  
Jennifer T. Fink ◽  
Elizabeth M. Magnan ◽  
Heather M. Johnson ◽  
Lauren M. Bednarz ◽  
Glenn O. Allen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Quality Of Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Population Based ◽  
Obesity And Diabetes

P6368Blood pressure control in a registry of clinical practice, PINNACLE-BRAZIL REGISTRY

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Avezum ◽  
A Cordeiro Mattos ◽  
G B F Oliveira ◽  
I M Pinto ◽  
A R Rombaldi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Significant Proportion ◽  
Case Report Form ◽  
Current Guideline ◽  
Antihypertensive Medications ◽  
Adequate Control

Abstract Introduction The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally. Purpose We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry Methods Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure <140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. Conclusion The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. Acknowledgement/Funding ACC Foundation

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