Improving blood pressure screening and control in primary care: a quality initiative

Abstract

Background: Hypertension costs the United States healthcare system billions of dollars and accounts for 1 in 6 deaths annually. Management of hypertension is a priority in primary care settings. Strategies to prevent the adverse health effects of hypertension in the United States include increasing awareness of the health risks of uncontrolled hypertension, promoting the use of healthcare teams to manage hypertension, and empowering patients to use self-measured blood pressure monitoring. Local Problem: To address the high rate (58%) of uncontrolled hypertension at a family practice clinic in Montana, a QI project was implemented aimed at improving blood pressure screening, management, and control. Methods: The Knowledge to Action model guided the development of a workflow that incorporated an existing hypertension management policy based on USPSTF hypertension screening and management recommendations. Interventions: Interventions were implemented over four weeks. All patients presenting to the clinic with a blood pressure > or = 140/90 were rescreened at the end of the visit. If the blood pressure remained elevated, the clinic staff was asked to provide an informational packet and ask the patient to obtain home blood pressure measurements or return in 7-14 days for a blood pressure check. Individuals with three elevated blood pressures on three separate occasions were referred to their care team for further hypertensive management. Results: The project goals were not achieved; however, the percentage of hypertensive patients with a blood pressure > or = 140/90 decreased by 4%. Conclusion: The QI initiative resulted in a modest increase in hypertension control for the project site. Although goals were not met, the project provided insight into hypertension management barriers, including time constraints on the providers and staff, patient willingness to engage in serial blood pressure measurements, and readiness of providers and patients to escalate hypertensive medication therapy.