The impact of routine follow-up with health care teams on blood pressure control among patients with hypertension

2019 ◽  
Vol 33 (6) ◽  
pp. 466-474
Author(s):  
Hui-Juan Zuo ◽  
Ji-Xiang Ma ◽  
Jin-Wen Wang ◽  
Xiao-Rong Chen ◽  
Lei Hou
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Health Care Teams ◽  
The Impact

scholarly journals Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dylan Collins ◽  
Laura Inglin ◽  
Tiina Laatikainen ◽  
Mekhri Shoismatuloeva ◽  
Dilorom Sultonova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Primary Health Care ◽  
Blood Pressure Control ◽  
Regression Models ◽  
Pressure Control ◽  
Primary Health ◽  
Essential Interventions ◽  
Clinical Records

Abstract Background The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. Methods The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. Results 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. Conclusions It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.

scholarly journals Association between attendance at outpatient follow-up appointments and blood pressure control among patients with hypertension

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sajid Mahmood ◽  
Zahraa Jalal ◽  
Muhammad Abdul Hadi ◽  
Kifayat Ullah Shah
Keyword(s):  
Blood Pressure ◽  
Treatment Outcomes ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Healthcare Settings ◽  
Co Morbidity ◽  
The Impact

Abstract Objective The aim of this study was to assess the impact of regularity in treatment follow-up appointments on treatment outcomes among hypertensive patients attending different healthcare settings in Islamabad, Pakistan. Additionally, factors associated with regularity in treatment follow-up were also identified. Methods A cross-sectional study was undertaken in selected primary, secondary and tertiary healthcare settings between September, 2017 and December, 2018 in Islamabad, Pakistan. A structured data collection form was used to gather sociodemographic and clinical data of recruited patients. Binary logistic regression analyses were undertaken to determine association between regularity in treatment follow-up appointments and blood pressure control and to determine covariates significantly associated with regularity in treatment follow-up appointments. Results A total of 662 patients with hypertension participated in the study. More than half 346 (52%) of the patients were females. The mean age of participants was 54 ± 12 years. Only 274 (41%) patients regularly attended treatment follow-up appointments. Regression analysis found that regular treatment follow-up was an independent predictor of controlled blood pressure (OR 1.561 [95% CI 1.102–2.211; P = 0.024]). Gender (OR 1.720 [95% CI 1.259–2.350; P = 0.001]), age (OR 1.462 [CI 95%:1.059–2.020; P = 0.021]), higher education (OR 1.7 [95% CI 1.041–2.778; P = 0.034]), entitlement to free medical care (OR 3.166 [95% CI 2.284–4.388; P = 0.0001]), treatment duration (OR 1.788 [95% CI 1.288–2.483; P = 0.001]), number of medications (OR 1.585 [95% CI 1.259–1.996; P = 0.0001]), presence of co-morbidity (OR 3.214 [95% CI 2.248–4.593; P = 0.0001]) and medication adherence (OR 6.231 [95% CI 4.264–9.106; P = 0.0001]) were significantly associated with regularity in treatment follow-up appointments. Conclusion Attendance at follow-up visits was alarmingly low among patients with hypertension in Pakistan which may explain poor treatment outcomes in patients. Evidence-based targeted interventions should be developed and implemented, considering local needs, to improve attendance at treatment follow-up appointments.

scholarly journals Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

Medicine ◽  
2016 ◽  
Vol 95 (14) ◽  
pp. e3233 ◽  
Author(s):  
Shangfeng Tang ◽  
Ghose Bishwajit ◽  
Lu Ji ◽  
Da Feng ◽  
Haiqing Fang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Hypertensive Patients

scholarly journals Risk factors of uncontrolled hypertension in urban slums of Central India : A Community health worker based two-year follow up

2021 ◽  
Author(s):  
Abhijit P Pakhare ◽  
Anuja Lahiri ◽  
Neelesh Shrivastava ◽  
N Subba Krishna ◽  
Ankur Joshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Uncontrolled Hypertension ◽  
Optimal Blood Pressure

AbstractBackgroundHypertension is a leading cause of cardiovascular diseases its control is poor. There exists heterogeneity in levels of blood-pressure control among various population sub-groups. Present study conducted in framework of National Program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) in India, aims to estimate proportion of optimal blood pressure control and identify potential risk factors pertaining uncontrolled hypertension consequent to initial screening.MethodsWe conceived a cohort of individuals with hypertension confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen Accredited Social Health Activists (ASHAs) were trained from within these urban slum communities. Individuals with hypertension were linked to primary care providers and followed-up for next two years. Obtaining optimal blood-pressure control (defined as SBP< 140 and DBP<90 mm of Hg) was a key outcome. Role of baseline anthropometric, and CVD risk factors was evaluated as predictors of blood-pressure control on univariate and multivariate analysis.ResultsOf a total of 6174 individuals, 1571 (25.4%) had hypertension, of which 813 were previously known and 758 were newly detected during baseline survey. Two year follow up was completed for 1177 (74.9%). Blood-pressure was optimally controlled in 301 (26%) at baseline, and in 442 (38%) individuals at two years (absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical-inactivity, higher BMI and newly diagnosed hypertension were significantly associated with uncontrolled blood-pressure.ConclusionsIn the current study we found about six of every ten individuals with hypertension were on-treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Kerrilynn C Hennessey ◽  
Carolyn Hickman ◽  
Brianne Krawczyk ◽  
Michelle Opare ◽  
Leslie Churchwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
Low Income ◽  
Health Workers ◽  
Pressure Control ◽  
Low Income Population ◽  
Early Results ◽  
Patient Reported ◽  
The Impact

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

scholarly journals Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Theresa Tiffe ◽  
Caroline Morbach ◽  
Viktoria Rücker ◽  
Götz Gelbrich ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Pressure Control ◽  
Population Based ◽  
Blood Pressure Target ◽  
Successful Implementation ◽  
Inverse Association ◽  
The Impact

Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.

scholarly journals Effect of Smartphone-Enabled Health Monitoring Devices vs Regular Follow-up on Blood Pressure Control Among Patients After Myocardial Infarction

2020 ◽  
Vol 3 (4) ◽  
pp. e202165 ◽  
Author(s):  
Roderick W. Treskes ◽  
Loes A. M. van Winden ◽  
Nicole van Keulen ◽  
Enno T. van der Velde ◽  
Saskia L. M. A. Beeres ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Health Monitoring ◽  
Pressure Control ◽  
Monitoring Devices
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