Quality Improvement Initiative in Primary Care to Control Hypertension (Spotlight Poster)

Background: CDC reports hypertension (HTN) is the leading risk factor for CVD, which is the leading cause of death in the U.S. Ambulatory blood pressure management (ABPM) is a useful diagnostic tool for the management of HTN. Research found targeted strategies involve intervention to increase awareness, treatment, and control in individuals. White coat effect can be a limitation in blood pressure (BP) results. We examined ABPM with specific format that gives a better picture of the normal fluctuation in BP levels in office and in nurse visits. We examined how provider and nursing intervention can directly affect BP. The plan was to discover if collaboration of nurses and providers could influence adherence, compliance, lifestyle, exercise efforts, and diet. We determined improved clinical outcome as a result of APBM.
Methods: The research involved ABPM during office and nurse visits. We utilized the hypertension dashboard to track patient's with BP over 140/90 and called them to schedule a nurse visit appointment after they were seen by their provider for HTN follow-up. The population studied was those age over 18 years old with BP greater than 140/90. Research methods included observation and interviews with individual patients during office visits with providers and nurse. The study duration was for one year. Intervention involved comprehensive care strategy on lifestyle and adherence to treatment. Home BP readings were also taken under consideration. Patients were encouraged to bring their home BP equipment to their appointments to assure they were well calibrated in comparison to the office equipment. Patients were educated on correct BP monitoring procedure.
Results: Main findings using data: Participants showed improvement in BP after office visit goal setting and nurse visits. ABPM results show importance of education by providers and nurses. The results showed a steady improvement per quarter of BP. The 4th quarter of 2021 showed 75.5% improvement in BP readings. The 1st quarter of 2022 showed 76%, the 2nd quarter of 2022 showed 80.5%, and the 3rd quarter of 2022 showed an 82% improvement in BP readings.
Conclusions/discussion: Findings determined the APBM intervention was successful in demonstrating focused intervention and education with providers and nurses. Results were particularly striking for the approach as it capitalizes on existing patient interest and participation by patient, providers, and nurse. This is significant because it demonstrates provider- and nurse-focused expertise in ABPM. It is a low cost, sustainable strategy for effectively managing HTN in ambulatory care settings. We were able to assess patient's response to antihypertensive therapy. Many patients reported increased stress, decrease in exercise, and increased eating at home related to COVID-19 pandemic. There was an increase in patient follow-up and nurse visit for BP check. Patients had improved experience, improved BP results, increase in satisfaction, and increase in safety and patient health. Providers had improved job satisfaction, improved work life balance, decreased burnout, and decreased turnover. Staff had improved job satisfaction, increased opportunity for growth, and improved team culture.