Reaching the Hard-to-Reach: Outcomes of the Severe Hypertension Outreach Intervention
| Autor: | Bradi B. Granger, Tracy Stillwell, Howard Eisenson, Jennifer C. Deyo, Lynn Fitzgerald, Ezra Pak-Harvey, Carolyn Crowder, Lynne Jung, Thomas Granger, Linda Small, Holly Biola, Joan Chaplin, Tiffany Hayes, Bina Patel |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Epidemiology Diastole Blood Pressure Primary care Pharmacists 01 natural sciences 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Health care medicine Humans In patient 030212 general & internal medicine 0101 mathematics Antihypertensive Agents Primary Health Care business.industry 010102 general mathematics Public Health Environmental and Occupational Health Middle Aged Outreach Blood pressure Relative risk Hypertension Emergency medicine Female business |
| Zdroj: | American Journal of Preventive Medicine. 59:725-732 |
| ISSN: | 0749-3797 |
| DOI: | 10.1016/j.amepre.2020.05.030 |
| Popis: | Severe hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) is associated with a twofold increase in the relative risk of death. At the authors' Federally Qualified Health Center in the Southeast, 39% of adults (n=8,695) had hypertension, and 3% (n=235) were severe. The purpose of this project was to lower blood pressure and improve the proportion of patients achieving the Agency for Healthcare Research and Quality goal for blood pressure.This quality improvement project was performed in 2017 in three 3-month Plan, Do, Study, Act cycles using a multidisciplinary outreach model in a community-based primary care setting. A clinical team including physicians, nurses, patient navigators, behavioral health counselors, and pharmacists contacted adult patients with severe hypertension (≥180/110 mmHg), scheduled visits, and established blood pressure and medication management goals. The data review and analysis concluded in 2019.Among patients with blood pressure ≥180/110 mmHg (n=235), the average age was 57 years (SD=12 years), 37% (n=87) were male, 82% (n=193) were Black, and 46% (n=108) were uninsured. The majority of those contacted attended a follow-up appointment within the 9-month project (77%, n=181) and achieved an improved systolic blood pressure (87%, n=167) and diastolic blood pressure (76%, n=146). Target blood pressure of140/90 mmHg was achieved in 29% of patients (n=53). Medication possession ratio improved from 23% to 40% among patients reached by pharmacists (n=30). Fewer deaths occurred in those reached by the intervention than in those not reached (n=1 vs n=3).Multidisciplinary outreach and use of evidence-based guidelines (Eighth Joint National Committee) were associated with lower blood pressure in patients with severe hypertension. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect