Systems for care of hypertension in the United States.
Control of hypertension in recent clinical trials varies from 48% to 65%. However, in community care of hypertension in the United States, estimates of control of hypertension are far lower. The United States has no single system of care; however, several care systems can be identified for comparison, such as the Department of Veterans Affairs, managed care organizations, and the Indian Health Service. This review compares control of hypertension in certain centers in these systems with that achieved in clinical trials and in the community at large. Certain components of care systems are assessed for their contribution to the control of hypertension. The author concludes that for community control of hypertension to approach that achieved in clinical trials, the use of physician extenders, together with reduced or minimal cost of medication, improved education of providers with feedback, and computerization of management systems will be needed. In addition, specific interventions targeted to medically underserved groups will be required.
Krakoff
Lawrence R
LR
Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA. lawrence.krakoff@ehmc.com
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D002986:Clinical Trials as Topic / Q000379:methods; D003153:Community Health Services / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D005568:Forms and Records Control / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008329:Managed Care Programs / Q000458:organization & administration; D024382:Professional Role; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D016549:United States Indian Health Service
D000959:Antihypertensive Agents