Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services

Barrera, Lena; Oviedo, Diana G.; Silva, Álvaro; Tovar, Diego; Méndez, Fabián

doi:10.1177/00469580211047043

Cited by 12 publications

(15 citation statements)

References 43 publications

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“…Women are a group that warrant particular consideration in Colombia because they comprise 70–80% of the population of patients with hypertension who attend subsidized primary care services (i.e., healthcare services for the most economically deprived portion of the population) [ 44 ]. While the prevalence of hypertension is not necessarily different in men and women, the trajectory of increasing BP over the lifespan is steeper in women than men from the third decade onwards [ 45 ].…”

Section: Issues In Hypertension Managementmentioning

confidence: 99%

See 1 more Smart Citation

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

Molina de Salazar,

Coca,

Alcocer

et al. 2024

Am J Cardiovasc Drugs

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Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP > 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.

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Section: Issues In Hypertension Managementmentioning

confidence: 99%

“…Reported BP control rates in Colombia vary from 37.1 to 66.4% (Table 1 ) [ 10 , 11 , 17 , 19 , 21 , 44 ]. In a primary care study by Barrera and colleagues, 38.4% of treated patients with hypertension had BP controlled to recommended levels.…”

Section: Issues In Hypertension Managementmentioning

confidence: 99%

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

Molina de Salazar,

Coca,

Alcocer

et al. 2024

Am J Cardiovasc Drugs

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“…Continuity of care has been associated with better clinical outcomes, especially in chronic diseases such as hypertension [41] and diabets [42]. It is also associated with fewer emegency room attendances [42,43], fewer hospitalisations [42,44], high uptake of immunisations [45] and low mortality [42,46].…”

Section: Results In Relation To Other Studiesmentioning

confidence: 99%

Practice list size, workforce composition and performance in English General Practice: A Latent Profile Analysis

Kayira,

Painter,

Mathur

et al. 2024

Preprint

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Background General practices in England have grown in size from traditionally small, General Practitioner (GP) led practices to large multidisciplinary enterprises. We assessed the effect of practice list size and workforce composition on practice performance in clinical outcomes and patient experience. Methods We linked five English practice-level datasets relating to workforce, list size, age, deprivation, rurality, patient experience and Quality and Outcomes Framework (QOF) and non-QOF clinical processes and outcomes. Latent Profile Analysis (LPA) was used to cluster general practices into groups based on list size and workforce composition. Bayesian Information Criterion, Akaike Information Criterion and deliberation within the research team were used to determine the most informative number of groups. One-way ANOVA was used to assess how groups differed on indicator variables and other variables of interest. Linear regression was used to assess the association between practice group and practice performance. Results A total of 6024 practices were available for class assignment. We determined that a 3-class grouping provided the most meaningful interpretation; 4494 (74.6%) were classified as ‘Small GP-reliant practices’, 1400 (23.2%) were labelled ‘Medium-size GP-led practices with a multidisciplinary team (MDT) input’ and 131 (2.2%) practices were named ‘Large multidisciplinary practices’. Small GP-reliant practices outperformed larger multidisciplinary practices on all patient-reported indicators except on confidence and trust where medium-size GP-led practices with MDT input had favourable ratings. There was no difference in performance between small GP-reliant practices and larger multidisciplinary practices on QOF incentivised indicators except on asthma reviews where medium-size GP-led practices with MDT input performed worse than smaller GP-reliant practices and immunisation coverage where the same group performed better than smaller GP-reliant practices. For non-incentivised indicators, larger multidisciplinary practices had higher cancer detection rates than smaller GP-reliant practices. Conclusion Small GP-reliant practices were found to provide better access, continuity, patient experience and satisfaction with care. Larger multidisciplinary practices had higher cancer detection rates but no effect on other clinical processes and outcomes. As England moves towards larger multidisciplinary practices efforts should be made to preserve high-quality patient experience.

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“…A stronger association between team-based COC and CVD risk reduction was found among patients with unsatisfactory blood pressure control, those <65 years old and those with fewer comorbidities (CCI<4) at baseline. It has been shown in the previous study that COC can help to achieve the blood pressure control, and thus improve the overall health of the patients with hypertension (6). As an alternative pattern for individual-based COC, the team-based COC can be more effective for the patients with poor blood pressure control, who deserve higher priority in the delivery of COC service.…”

Section: Comparison With Existing Literaturementioning

confidence: 98%

“…Traditional COC in primary care is mainly viewed as the relationship between the patient and a designated practitioner that extends beyond specific episodes of illness or diseases (4), which could also be termed individual-based COC. COC was found to increase the chance of achieving blood pressure targets and improved quality of life (5)(6)(7) in patients with hypertension. However, assigning a physician to the patient for long-term COC requires the primary care system to be adequately and appropriately staffed, which is challenging in many public healthcare sectors, especially for those in resource-restricted settings (8).…”

Section: Introductionmentioning

confidence: 99%

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

Chin

et al. 2023

Br J Gen Pract

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Background: Continuity of care (COC) is associated with improved health outcomes in hypertension patients. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for hypertension patients. Aim: This study aimed to investigate the effectiveness of team-based COC on cardiovascular disease prevention in patients with hypertension. Design and setting: A retrospective cohort study in primary care setting. Methods: 421,640 patients visiting public primary care clinics in Hong Kong from 2008 to 2018 were included in the study. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines (RCS) were applied to model the association between the COC and the risk for CVDs and all-cause mortality. Results: Compared to participants in the lowest quartile of UPCI, the hazard ratio for overall CVD was 0.94 (0.92,0.96), 0.91 (0.89,0.93), and 0.90 (0.88,0.92) in the 2nd, 3rd and 4th quartile, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, the patients<65 years old and those with a Charlson Comorbidity Index<4 at baseline (Pinteraction<0.05), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60ml/min/1.73m2 at baseline. Conclusions: Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among hypertension patients, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.

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Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services

Cited by 12 publications

References 43 publications

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

Practice list size, workforce composition and performance in English General Practice: A Latent Profile Analysis

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

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