Hypertension and hyperlipidemia management in patients treated at community health centers.
OBJECTIVE: Community health centers (HCs) provide care for millions of medically underserved Americans with disproportionate burdens of hypertension and hyperlipidemia. For both conditions, treatment guidelines recently became more stringent and quality improvement (QI) efforts have intensified. We assessed hypertension and hyperlipidemia management in HCs during this time of guideline revision and increased QI efforts. DESIGN: Cross-sectional chart review. SETTING AND PARTICIPANTS: Eleven Midwestern HCs for 2000 and 9 for 2002 provided audit data from 2,976 randomly chosen patients with hypertension and/or hyperlipidemia. MEASUREMENT: Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI/VII) and National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines were used to assess management of these conditions. RESULTS: Hypertension (2000, N=808; 2002, N=692) and hyperlipidemia (2000, N=774; 2002, N=702) outcomes improved for specific clinical subgroups. Hypertensive patients with 1 or more cardiovascular risk factors demonstrated significant improvement (34% vs. 45% controlled at <140/90 mm Hg, p=0.02). Hypertension control for persons with diabetes, renal failure and heart failure increased (16% vs. 28% controlled at <130/85 mm Hg, p=0.006). LDL control increased significantly for patients with 2 or more risk factors (39% vs. 58% controlled at <130 mg/dl, p=0.008). Other clinical subgroups showed trends toward better control, although there was insufficient power to detect significant differences for these groups. CONCLUSION: Hypertension and hyperlipidemia outcomes improved for some risk groups; however, ongoing QI is necessary.
Departments of Medicine and Health Studies, Diabetes Research and Training Center, The University of Chicago, Illinois (ACK, MLD, JXZ, JS, JL, MHC); North Woods Community Health Center, Minong, Wisconsin (JFH); Health Resources and Services Administration, Chicago, Illinois (SAL); University Of Evansville, Evansville, Indiana (CTS). Ms. Kirchhoff is currently with the University of Washington, Ms. Schlichting is with the University of Michigan, Ms. Levie is with the Attorney Registration and Disciplinary Commission, Dr. Harrison is with South Lane Medical Group, Cottage Grove, Oregon, and Dr. Lippold is with the Centers for Disease Control City of Chicago Tuberculosis Program.
Anne C
AC
Kirchhoff
Melinda L
ML
Drum
James X
JX
Zhang
Jennifer
J
Schlichting
Jessica
J
Levie
James F
JF
Harrison
Susan A
SA
Lippold
Cynthia T
CT
Schaefer
Marshall H
MH
Chin