Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Abstract

Objective

A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model.

Design and setting

Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention.

Intervention

Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols.

Patients

Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively.

Main outcome measures

Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured.

Results

In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p = .043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations.

Conclusion

Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.

KEY POINTS

• Hypertension is common and often suboptimally treated in relation to existing guidelines.

• This register study evaluates the results of a staff training intervention promoting nurse-led care.

• The intervention had an impact on measurement techniques, drug choice and improved cholesterol control.

Keywords:

• blood pressure
• hypertension
• primary healthcare
• intervention
• nurse

Acknowledgements

This study would not be possible without the clinical data provided from all the PCCs in the region of Västra Götaland to our regional registers. We thank the PCCs, the patients they care for and the Regional board, for financing and operating the registers.

Ethics

The regional registers used in this study to provide data are regulated by Swedish laws. The quality register QregPV is regulated by the Patient Data Act, according to which the PCCs collecting data are legally responsible for informing the patients about what data they collect and for what purposes. The patients have the right to decline participation, and may at any time get collected data deleted by contacting the register centre. When using the data for research, it is therefore not required to further inform or get consent from the patients. The health data registers Vega and Digitalis are regulated by the Law on Health Data Registers and collect data according to the law without requiring consent from the patients. The data are handled with absolute secrecy and extraction of data from the registers is strictly regulated. Research must be approved by an Ethical Review Board before data extraction from the registers. This study was approved by the Regional Ethical Review Board in Gothenburg with application number 1062-15 2016-02-16 and supplement application 2020-02839 2020-06-18.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The study was financed by the Local Research and Development Council, Skaraborg, Sweden, received funds from the Local Research and Development Board for Södra Älvsborg (grant number VGFOUSA-937483) and was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (grant number ALFGBG-965244).