Blood Pressure: Small Changes Yield Big Improvements

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Small, focused and inexpensive initiatives can significantly improve the quality of care for high blood pressure patients, researchers report in Circulation: Cardiovascular Quality and Outcomes.

In a study of the VA–Tennessee Valley Healthcare System, a multi-faceted initiative involving patient, nurse and physician education improved high blood pressure care and control in veterans.

Patient education activities were directed at raising awareness about current blood pressure and goal blood pressure, reinforced by nurses and physicians at clinic visits. Nurses distributed more than 30,000 blood pressure wallet cards to track clinic visits, document blood pressure, update medications and provide contact information.

Among the key findings, blood pressure control improved 4.2 percent among the 50,000 veterans with high blood pressure. This intervention led to another 2,335 patients with improved blood pressure control. The blood pressure control goal was 140/90 millimeters of mercury (mm Hg).

“On a population level, a 4.2 percent improvement can result in a large benefit because a few millimeters of mercury reduction in blood pressure translates into major benefits in prevention of stroke, heart attack and congestive heart failure,” said Christianne L. Roumie, M.D. M.P.H., lead author of the study and assistant professor of internal medicine at Vanderbilt University Medical Center in Nashville, Tenn.

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“Quality improvement initiatives are useful in the private sector and not just in the VA system,” said Roumie, who is also a staff physician at VA–Tennessee Valley Healthcare System.

All patients in the study had high blood pressure and ranged in age from 18 to about 90 years (average age 65). Many of the older veterans had chronic diseases, such as diabetes or heart disease.

“In my opinion, the blood pressure wallet card has been the most beneficial of the patient education interventions because it gives the patient a lot of control over their own chronic illness,” Roumie said. “It is important for patients to be actively involved with their healthcare team to improve the quality of their care and get their blood pressure to goal.”

Researchers identified several factors that contributed to their study’s success. Initially, they identified local barriers. An expert group from the healthcare system analyzed the barriers to improve the quality of care for high blood pressure patients.

After identifying key areas of improvement, researchers found that small, easy-to-accomplish interventions often worked better than large, overwhelming projects.

Other healthcare groups should analyze their system barriers to improve care and control high blood pressure to design the most effective interventions, Roumie said.

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