Report Suggests Rapid-Induction Group Clinic May Be Effective Method of Increasing Rates of Hypertension Control
- Among 504 Veterans with chronically treated but persistently uncontrolled hypertension, more than half (54%) were able to rapidly lower their blood pressures to controlled levels within six weeks using a group clinic quality improvement initiative. Moreover, Veterans maintained BP control over the follow-up period (10 months after QI protocol completion).
- Adherence to the QI protocol predicted hypertension control at follow-up, even after controlling for multiple baseline variables (e.g., diabetes, body mass index, medication compliance).
- Two-thirds of Veterans without diabetes achieved hypertension control, including more than 80% of those who adhered to the group-clinic protocol.
Despite improvements in hypertension awareness and access to care, rates of blood pressure control remain below 50% in most population studies. From 10/04 through 5/05, nearly 22,000 Veterans were treated for chronic hypertension within primary care at the Michael DeBakey VAMC in Houston. Rates of BP control were 54% in 2005 for all Veterans with hypertension and without diabetes, and rates were 30% among Veterans with comorbid diabetes. Under the guidance of the primary care clinic director and nurse manager, a quality improvement (QI) program was initiated to specifically address persistent, uncontrolled hypertension. This report describes the process of care and outcomes of the QI initiative that used group clinics to rapidly induce hypertension control among 504 Veterans in a VA primary care setting. Patients with consistently high BP levels were asked to attend a series of clinic visits dedicated to BP control, and intensification of therapy was triggered by every uncontrolled measurement after accounting for adverse events. Eligible patients included those who had received chronic hypertension care, but had persistently elevated BP measurements despite ongoing treatment for a 90-day period prior to referral. Hypertension control was defined as a systolic BP of <140mmHg and a diastolic BP of <90mmHg – or a systolic BP of <130mmHg and a diastolic BP of <80mmHg for Veterans with diabetes.
- Results are from only one VAMC, and participation in the QI initiative was voluntary for both patients and clinicians.
- These results were not compared with patients in a concurrent, usual care group.
- Overall, VA has dramatically improved hypertension control over the past 5 years. For example, the hypertension group clinics have been used since 2006 at the Michael DeBakey VAMC and have contributed to ongoing improvements in their rates of hypertension control, now above 75%. The emphasis on rapidly bringing blood pressure into control over a short period of time is a key element of the success of this program and an important part of its clinical relevance.
This study was partly funded through HSR&D. Dr. Naik and Ms. Rodriguez are part of HSR&D’s Houston Center for Quality of Care and Utilization Studies.
Naik A, Rodriguez E, Rao R, et al. Rapid Induction of Hypertension Control in Primary Care. Circulation: Cardiovascular Quality and Outcomes September 2010;3(5):558-64.