Improving the Management of Hypertension in Adults Within the Primary Care Setting
Presentation
Overview
Overview
Description
Overview: Hypertension (HTN) is a highly modifiable disease that is commonly encountered but rarely taken under serious consideration within the primary care setting. Uncontrolled HTN is typically undertreated, neglected, or may go unrecognized. High blood pressure taxes cardiovascular functioning and damages arteries, raising the risk of stroke and heart disease.
Purpose: To implement a clinician-provider awareness quality improvement project to improve the control of hypertension in order to enhance an organizational Merit-Based Incentive Payment System benchmark within a primary care setting while lowering or avoiding therapeutic inertia, a significant barrier to care improvement.
Methods: Lewin’s Theory of Change as a theoretical framework for promoting positive change in attitudes and practice measures, was utilized in a small standalone primary clinic located in Carolina Beach, North Carolina. Primary care patients with a blood pressure reading greater than 140/90 were included in the quality improvement project after vetting. A multifaceted approach including staff education and clinical practice decision support guidelines were implemented to inform providers/staff on HTN management and included patient education. Patients were educated on how to properly self-monitor blood pressure at home and record readings. Patients were tracked through an initial visit followed by three follow-up visits.
Findings: There was a substantial decrease in providers' clinical inertia and patients’ blood pressure readings over a 12-week period. Linking provider awareness to antihypertensive medication alteration was found to be of no statistical significance.
Conclusions: The results of this quality improvement program demonstrate that clinical change can occur on a micro-level, in a small independent outpatient clinic with limited resources as compared to larger healthcare organizations that may have access to unlimited clinical resources, such as additional personnel and significant sources of funding at their disposal. However, this QI project has been proven to be sustainable over a relatively short period of time, with a considerably small clinical staff having the potential to become a primary clinical indicator of performance over longer timespans, as it does not require any special funding, nor does it require a bevy of resources in driving overall health standards for primary care patients. This has implications for encouraging sound practice standards that are evidence-based. The overall sustainability of such a program may ultimately rely on an integrated multidisciplinary or staff approach to actively combat and recognize clinical inertia before it becomes ingrained in provider behaviors and general attitudes. Practical
Implications: After completion of the quality improvement intervention, provider attitudes and behavior towards actively managing HTN, coupled with patient education and attentiveness to mechanisms that influence outcomes other than simply anti-hypertensives, are responsible for the relative success of this quality improvement project. The effect of informing clinicians of their performance, bolstering clinician awareness, and furnishing educational resources with the intention of decreasing clinical inertia as perceived by the two providers was clearly established in the data interpretation of the Likert scores and the corresponding reduced rates of systolic and diastolic blood pressures over a three-month span of time.
