Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study
| Autor: | Roser Vallès-Fernández, Alícia Àlvarez-Lázaro, Teresa Rodriguez-Blanco, Josep Mª Bonet-Simó, Magdalena Rosell-Murphy, Gemma Prieto-De Lamo, Imma Olmedo-Muñoz, Eva Bellerino-Serrano, Mª Socorro Alonso-Ortega, Fina Martínez-Frutos, Lucas Mengual-Martínez, Alícia Franzi-Sisó, Sonia Mimoso-Moreno, Juan Carlos Martínez-Vindel |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Pediatrics education.field_of_study Quality management business.industry Research Public health Population Alternative medicine Repeated measures design General Medicine Odds Blood pressure Intervention (counseling) Physical therapy Medicine General practice / Family practice business education |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2011-000507 |
| Popis: | Objective The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. Methods Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. Results The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). Conclusions The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. Trial registration ClinicalTrials.gov MS: 1998275938244441. Article summary Article focus To assess the effectiveness of a QI programme targeting health professionals to optimise BP control in hypertensive patients. Other factors associated with BP control were analysed. Key messages The QI plan aimed at PHCTs (doctors, nurses and administrative staff) implemented in our study has proven effective to improve hypertension control. A history of a cardiovascular event has a positive effect in BP control. The addition of different antihypertensive drugs to the management of hypertensive patients without considering other aggravating factors does not guarantee a better BP control. Strengths and limitations of this study The population-based design and mixed-effects modelling on repeated measures were the main strengths of this study. The mixed models approach is a powerful method for analysing data from longitudinal studies, which include multiple measurements on each participant. Most of the intervention effort in this study was implemented with few additional resources. The duration of the study can be considered the main limitation of this investigation. Longer term studies that include unmeasured factors are needed to determine the effectiveness and cost-effectiveness of this measure and the impact of a reduction in BP values on cardiovascular morbimortality in the hypertensive population. |
| Databáze: | OpenAIRE |
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