A Community Based Intervention for Hypertension Implement by a Physician Hospital Organization
Keywords: hypertension, intervention, community, clinical integration
Hypertension is a silent and often unaware condition. The American Heart Association statistics show that hypertension prevalence is 73.0 million Americans or 33.6% of the population. As many as 30% of Americans are unaware they have hypertension and, of the ones that are aware, two thirds of them are not being controlled to blood pressures of less than 140/90. A midsized Physician Hospital Organization (PHO) in the Midwest is working to pioneer a community based intervention model that implements a two pronged attack to reduce the negative consequences of hypertension. Their approach emphasizes physician compliance to published guidelines (two office visits and one serum lab test in a year), as well as patient education through focused outreach and long term evaluation and tracking of high risk patients. Working closely with its clinical integration vendor, a data warehouse has been assembled on a vast majority of their physician’s patients which includes information from practice management systems, hospitals, and laboratory. A two staged sampling frame is used to determine the overall incidence of hypertension in the patient population and also allows selected physicians to track a representative population of high risk patients. The overlay of patient education initiatives on geographically derived population rates allows for unique resolution on the impact of community interventions. Initial analysis from a pilot study illustrates the importance of multiple methods of compliance. Compliance with providing serum or attending two follow-up visits was associated with a 50% more liklihood of safe blood pressure levels (140/90 or below) compared to no compliance. The same pilot study showed that participants who lowered their blood pressure between visits were more likely to have education and to be following pharmaceutically oriented preventative measures. This analysis was conducted on 57 individuals which constitutes roughly 15% of the study sample. Communities can be influenced by the amount and type of information and services that are available to them thus impacting behaviors that pose a risk to health (Fortmann et al. 1995). This community based approach for quality improvement recognize the importance of patient education, physician involvement, and structured patient tracking to develop effective interventions to increase compliance and decrease the long-term impact of hypertension on society.