Improvement of hypertension management by structured physician education and feedback system: cluster randomized trial.
BACKGROUND
We aimed to assess whether hypertension management with a structured physician information program and a feedback system leads to improved blood pressure (BP) control and cardiovascular outcomes.


METHODS
Cluster randomized (3 : 1), open, monitored, multicenter trial in Germany. Primary care-based physicians in the information group (IG) received detailed training on hypertension guidelines, feedback on target-level attainment, and a reminder to intensify treatment after each patient visit, whereas the observation/control group (CG) did not receive any such measures. A three-level mixed model was developed. Time-independent level differences between groups, group-independent changes, and nonparallel group-specific changes over time were tested.


RESULTS
A total of 15 041 (78.1%) hypertensive patients were in the IG and 4213 (21.9%) in the CG. By 1-year follow-up, 82.9% of patients in the IG and 81.5% in the CG remained in the study. The guideline-oriented BP target was attained by 56.8% in the IG and 52.5% in the CG (+4.3%, P = 0.03), whereas the individual BP target was attained by 57.0% in the IG and 51% in the CG (P = NS). BP control in the IG was achieved 2 months earlier on average. Clinical inertia, defined as the absence of medication changes, despite noncontrol of BP, occurred significantly less often in the IG group. One-year cardiovascular outcomes did not differ between groups.


CONCLUSIONS
The delivery of systematic information in connection with a feedback system reduces clinical inertia and improves guideline adherence. Although compared with earlier studies, the hypertension control rates obtained are higher, there is still considerable room for improvement.
Lüders
Stefan
S
St. Josefs Hospital, Cloppenburg, Germany.
Schrader
Joachim
J
Schmieder
Roland E
RE
Smolka
Wenefrieda
W
Wegscheider
Karl
K
Bestehorn
Kurt
K
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001794:Blood Pressure / Q000187:drug effects; D016000:Cluster Analysis; D004502:Education, Medical, Continuing; D030141:Feedback, Psychological; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D017010:Reminder Systems; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents