title: [Cycles of improvement of the hypertensive patient's care: risk-cycle study].
abstract: BACKGROUND
  Frequently we found deficiencies in the management of cardiovascular risk factors on hypertensive patients in primary care.
  
  
  OBJECTIVE
  This study was to evaluate the effect of a quality improvement intervention in the care of cardiovascular risk factors in hypertensive patients.
  
  
  METHODS
  Quality assurance study. Two health centres with fourteen family doctors. One centre (seven doctors) was assigned to receive a quality improvement intervention while the other centre was assigned the control group. 482 hypertensive patients were in the study group (64% females, mean age 61,4 years (SD 6,8)), and 360 were in the control group (63% females, mean age 60,7 (SD 7,4)). Quality improvement circles consisting of audit, feedback, training sessions, and guidelines discussion. Process criteria of hypertension control, blood pressure, weight, lipids, smoking, cardiovascular risk and antihypertensive drugs used were measurement before intervention and again one year later.
  
  
  RESULTS
  The mean improvement in process criteria after the intervention was 5,3 percent points (CI95%:3,7-6,9). Systolic blood pressure was decreased by 3,5 mmHg(IC95%:1,6-5,3) and Diastolic blood pressure by 2,5 mmHg(IC95%:1,3-3,8). Adequate BP control was significantly increased in the intervention group (29,1% to 40,9%;p<0,01), while no effect was achieved in the control group. Absolute cardiovascular risk decreased (15,86 to14,34%, p<0.01) in the study group, with no changes in the control group. Absolute risk decreases 2,07(IC95%:1,21-2,93) and relative risk 0,25 (IC95%:0,14-0,35) percent points.
  
  
  CONCLUSIONS
  The quality intervention was effective in improving the quality care process and decreased blood pressure and absolute and relative cardiovascular risk.
authors.affiliation: Unidad de Investigación, Centro de Salud La Alamedilla, Salamanca. Lgarciao@usal.es
authors.forename: Luis
authors.initials: L
authors.lastname: García-Ortiz
authors.forename: Ignácio
authors.initials: I
authors.lastname: Santos-Rodríguez
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gómez-Marcos
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez-Fernández
authors.forename: Emiliano
authors.initials: E
authors.lastname: Rodríguez-Sánchez
authors.forename: Luis J
authors.initials: LJ
authors.lastname: González-Elena
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards; D010507:Periodicity; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D013030:Spain