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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1053 — Hypertension and Diabetes: Blood Pressure Goals Endorsed by VA Primary Care Providers

Martins SB (GRECC and CHCE, VA Palo Alto Health Care System), Tu SW (Stanford University and VA Palo Alto Health Care System), Hoffman BB (VA Boston Health Care System), Farwell W (VA Boston Health Care System), Schlosser J (VA Bedford Health Care System), Kim N (VA Connecticut Health Care System), Chambers DA (GRECC and CHCE, VA Palo Alto Health Care System), Holmes TH (Stanford University and VA Palo Alto Health Care System), Goldstein MK (GRECC and CHCE, VA Palo Alto Health Care System)

Objectives:
Clinical practice guidelines published by different organizations often differ in their recommendations. VA/DoD guidelines for hypertension define the blood pressure (BP) target for patients with hypertension and diabetes as < 140/80 mmHg, while the Joint National Committee (JNC7) defines the target as < 130/80 mmHg. Clinician acceptance of guidelines for best practices is considered to be a pre-requisite for guideline adherence; yet, little is known about which guidelines VA PCPs are more likely to accept. As part of a study implementing ATHENA-Hypertension (ATHENA-HTN), a clinical decision support system for management of hypertension based on the VA/DoD guidelines, we surveyed VA PCPs, in order to characterize the BP targets endorsed by PCPs for patients with hypertension and diabetes.

Methods:
PCPs in the ATHENA-HTN study, each having their own panel of patients for whom they provide primary care, were asked to complete a baseline survey of demographics. On an end-of-trial survey, we asked what BP target the PCP believed was appropriate for patients with hypertension and diabetes, with response options: 1) 140/80, 2) 130/80, and 3) other (enter a BP). The survey did not identify the sources for answers (1) and (2). Responses were compared by age, gender, professional discipline (MD, nurse practitioner (NP), or physician assistant (PA)), years since clinical training program completion, years at VA, and clinic setting (medical center-based or community-based outpatient clinic (CBOC)), using the Van der Waerden test for continuous variables and Fischer’s Exact Test for categorical variables.

Results:
92/105 (88%) of clinicians responded to post-trial surveys and, of those, 89/92 (97%) responded to the BP target question. 46 were MDs, 41 were NPs, and 2 were PAs. 59/92 (66%) were women. PCPs endorsed BP targets as follows: 4/92 (4%) chose 140/80; 74/92 (83%) chose 130/80; 9/92 (10%) wrote in BP targets below 130/80, such as 120/70; and 2/92 (2%) wrote in BP targets between 130/80 and 140/80. No significant associations were observed between endorsed target BP and age, years of training, years at the VA, or clinic setting. Target BP was marginally associated with professional discipline (p = 0.045, multiplicity adjusted p = 0.27): MDs may have been more likely than NPs or PAs to choose 130/80.

Implications:
The majority of VA clinicians surveyed endorsed the BP target for hypertension and diabetes recommended by JNC 7 rather than the VA/DoD guideline.

Impacts:
Survey of clinicians’ beliefs about best practices may inform future guideline implementations.


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