ABSTRACT
We evaluated use of a program to improve blood pressure measurement at 6 primary care clinics over a 6-month period. The program consisted of automated devices, clinical training, and support for systems change. Unannounced audits and electronic medical records provided evaluation data. Clinics used devices in 81.0% of encounters and used them as intended in 71.6% of encounters, but implementation fidelity varied. Intervention site systolic and diastolic blood pressure with terminal digit "0" decreased from 32.1% and 33.7% to 11.1% and 11.3%, respectively. Improvement occurred uniformly, regardless of sites' adherence to the measurement protocol. Providers rechecked blood pressure measurements less often post-intervention (from 23.5% to 8.1% of visits overall). Providers at sites with high protocol adherence were less likely to recheck measurements than those at low adherence sites. Comparison sites exhibited no change in terminal digit preference or repeat measurements. This study demonstrates that clinics can apply a pragmatic intervention to improve blood pressure measurement. Additional refinement may improve implementation fidelity.
Subject(s)
Blood Pressure Determination , Hypertension/diagnosis , Patient Education as Topic/methods , Primary Health Care , Sphygmomanometers , Adult , Aged , Blood Pressure/physiology , Blood Pressure Determination/instrumentation , Blood Pressure Determination/methods , Female , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Humans , Hypertension/physiopathology , Hypertension/psychology , Male , Middle Aged , Primary Health Care/methods , Primary Health Care/standards , Quality ImprovementABSTRACT
Lifestyle modification is widely advocated as initial and adjuvant therapy for the treatment and prevention of hypertension. In addition to exercise, nutritional changes including sodium reduction, adoption of the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and weight loss have significant blood pressure lowering effects. The current challenge to clinicians has been developing and implementing practical and effective approaches for use in clinical practice. This review discusses the evidence supporting each current lifestyle recommendation, discusses evidence on specific programs or office based strategies, and provides practical advice. (c)1999 by Le Jacq Communications, Inc.
