[Cycles of improvement of the hypertensive patient's care: risk-cycle study].
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.
García-Ortiz
Luis
L
Unidad de Investigación, Centro de Salud La Alamedilla, Salamanca. Lgarciao@usal.es
Santos-Rodríguez
Ignácio
I
Gómez-Marcos
Manuel A
MA
Sánchez-Fernández
Pedro L
PL
Rodríguez-Sánchez
Emiliano
E
González-Elena
Luis J
LJ
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