September 15, 2010
Group Clinics Prove Effective in Improving Hypertension Control
HOUSTON - A quality-improvement initiative report published on September 14 in Circulation: Cardiovascular Quality and Outcomes shows group clinics implemented in the primary care setting can be extremely effective in helping individuals get their blood pressure under control.
“This effort is important because, in the United States, hypertension affects one in four adults, including two thirds of people over 60 years of age. Most studies show more than half of those treated do not have their blood pressure under control,” said Aanand D. Naik, M.D., first author of the study, a physician and researcher at the Michael E. DeBakey VA Medical Center (MEDVAMC). “Most patients who followed our program achieved control within six weeks and maintained it for the next year.”
The program, which relies on existing resources and personnel, uses group clinics, intensive appointment scheduling within a brief period, and standardized measurement techniques to focus efforts of patients and staff on lowering blood pressure. Implemented in 2006 at the MEDVAMC, the percentage of patients with their hypertension under control increased significantly from 54 percent in 2005 to more than 75 percent today.
In the study, 504 Veterans with treated but uncontrolled hypertension attended group clinic visits every other week for six weeks (or less if they achieved control sooner). Blood pressure measurements were taken at each session and compared against targeted levels and, if uncontrolled, treatment was escalated by clinicians. The mean reduction in systolic blood pressure was just over 20 mmHg for all patients and 53 percent achieved and maintained control through the following year. In all, two thirds of patients without diabetes achieved hypertension control.
Analyses performed to evaluate the results showed that following the protocol (attending group clinic appointments every two weeks until blood pressure fell within the controlled range) was the most important factor influencing a patient’s success.
“As Medicare and private insurers move to pay-for-performance reimbursement systems, the rapid-induction group clinic may be an effective method of improving the quality of routine hypertension care,” said J. Kalavar, M.D., MEDVAMC chief of staff and an initiator of the project. “The results of this important study suggest this approach can be implemented into a primary care practice and produce results similar to those described in clinical trials.”
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Awarded the Robert W. Carey Circle of Excellence Quality Award in 2007 and re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 120,000 veterans in southeast Texas. Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder Clinic; Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; Liver Transplant Center; VA Epilepsy and Cancer Centers of Excellence; VA Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research & Development Center of Excellence; VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; Mental Illness Research, Education and Clinical Center; and one of the VA’s six Parkinson’s Disease Research, Education, and Clinical Centers. Including the outpatient clinics in Beaumont, Conroe, Lufkin, Galveston, and Texas City, MEDVAMC outpatient clinics logged almost one million outpatient visits in fiscal year 2009. For the latest news releases and information about the MEDVAMC, visit www.houston.va.gov.