Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control

Abstract

IMPORTANCE Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal. OBJECTIVE To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates. DESIGN, SETTING, AND PARTICIPANTS This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019. EXPOSURES An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group). MAIN OUTCOMES AND MEASURES Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up. RESULTS A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups. CONCLUSIONS AND RELEVANCE This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden

“…The primary health care system in Sweden fits well with the goals for long-term management of hypertension in the population. A recent study in Sweden shows the effectiveness of education and feedback strategies for physicians in implementing the clinical guidelines for hypertension management at a primary care level in Sweden [ 18 ]. The primary health care system in China, however, has a considerably poorer quality of processes and outcomes [ 19 ].…”

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

“…A mixed clinic and home visits is recommended for follow-up care delivery; nevertheless, this would inevitably require computer-aided telehealth capabilities, clinical decision-support tools and infrastructure support in the context of rural health-care resources. A recent real-world trial conducted at the county setting reported the effectiveness of a healthcare intervention comprising education and feedback for PCPs through an electronic decision support system in overcoming clinical inertia [ 55 ]. From a service delivery perspective, the barriers (or facilitators) such as service sites, the training of PCPs, clinical capabilities and physician involvement should be incorporated in the formulation of evidence-based health care strategies intended to optimise the implementation of clinical practice recommendations in rural areas with resource limitations.…”

“Watch and Wait” Strategy for Multicystic Dysplastic Kidney (MCDK): Status Survey of Perceptions, Attitudes, and Treatment Selection in Chinese Pediatric Urologists and Pediatric Surgeons

“…Education level is the main factor affecting doctors' views on the diagnosis and management of some diseases ( 16 , 17 ). However, education level was not associated with different attitudes toward the management of MCDK among pediatric urologists and pediatric surgeons in this study.…”