The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care.
BACKGROUND
Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects. Effective programs to address this problem are lacking. We hypothesized that an information technology-supported management program could help improve blood pressure (BP) control.


RESULTS
This randomized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP >130/80 and daytime BP >135/85 mm Hg measured with ambulatory monitoring (ABPM). Intervention subjects received a BP monitor and access to an information technology-supported adherence and BP monitoring system providing nurses, pharmacists, and physicians with monthly reports. Control subjects received usual care. The mean (+/-SD) follow-up was 348 (+/-78) and 349 (+/-84) days in the intervention and control group, respectively. The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic (-11.9 versus -7.1 mm Hg; P<0.001) and diastolic BP (-6.6 versus -4.5 mm Hg; P=0.007). The proportion of subjects that achieved Canadian Guideline target BP (46.0% versus 28.6%) was also greater in the intervention group (P=0.006). We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control. The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents (P=0.03), more antihypertensive classes at study end (P=0.007), and a trend toward improved adherence measured by prescription refills (P=0.07).


CONCLUSIONS
This multidisciplinary information technology-supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting.
Rinfret
Stéphane
S
Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Lussier
Marie-Thérèse
MT
Peirce
Anthony
A
Duhamel
Fabie
F
Cossette
Sylvie
S
Lalonde
Lyne
L
Tremblay
Chantal
C
Guertin
Marie-Claude
MC
LeLorier
Jacques
J
Turgeon
Jacques
J
Hamet
Pavel
P
D000328:Adult; D000368:Aged; D000555:Ambulatory Care Information Systems / Q000458:organization & administration*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D011307:Drug Prescriptions; D005246:Feedback; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff; D010348:Patient Care Team / Q000458:organization & administration*; D010349:Patient Compliance; D010595:Pharmacists; D010820:Physicians; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D016896:Treatment Outcome
D000959:Antihypertensive Agents