Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1994 Oct;40:1742–1752.

Le contrôle de l'hypertension artérielle: effet d'une intervention réalisée auprès des médecins de famille.

Control of arterial hypertension: effectiveness of an intervention performed by family practitioners

M Aubin 1, L Vézina 1, J Maziade 1, N M Robitaille 1
PMCID: PMC2380384  PMID: 7950469

Abstract

OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension control practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Three hospital-based family medicine centres (FMCs) PARTICIPANTS: Two study groups of 100 randomly-selected adult patients each, who visited the study FMC before implementation of the hypertension program (from April 1, 1983 to March 31, 1984) or afterward (from April 1, 1986 to March 31, 1987). These patients were compared to patients from control FMCs A and B seen during the same time frames (100 patients before and after at FMC A and 60 at FMC B). INTERVENTIONS: 1) Educational sessions for physicians to standardize knowledge of the recommendations of the Canadian Hypertension Society on hypertension treatment and 2) specific operational incentives to improve hypertension control, including a reference guide placed in each physician's office, a specific hypertension follow-up form placed with each patient's chart, a recall card file, and hypertension information handouts. MAIN OUTCOME MEASURE: Blood pressure measurements recorded in patient charts. Hypertension control is determined from the Canadian Hypertension Society recommendations. RESULTS: The hypertension control rate was 52% in the study group before program implementation and 34.3% afterward (p = 0.01); the corresponding rates in the two control groups moved from 47.4% to 59.8% (p > 0.05) in Group A and from 40.7% to 39.3% (p > 0.05) in Group B. Patients listed in the recall card file were not controlled more frequently (33.3%) than those not listed (35.3%). CONCLUSION: This intervention did not improve physician practice regarding hypertension control. Clinicians did not follow the protocol as recommended. Physicians must be convinced that a change in their practice is needed before any specific strategies are introduced to support the change. Different suggestions and alternatives related to hypertension management are discussed.

Full text

PDF
1742

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adorian D., Silverberg D. S., Tomer D., Wamosher Z. Group discussions with the health care team--a method of improving care of hypertension in general practice. J Hum Hypertens. 1990 Jun;4(3):265–268. [PubMed] [Google Scholar]
  2. Aubin M., Vézina L., Fortin J. P., Bernard P. M. Un projet d'intervention efficace pour le dépistage de l'hypertension artérielle en médecine familiale. Union Med Can. 1992 Jul-Aug;121(4):227–232. [PubMed] [Google Scholar]
  3. Barnett G. O., Winickoff R. N., Morgan M. M., Zielstorff R. D. A computer-based monitoring system for follow-up of elevated blood pressure. Med Care. 1983 Apr;21(4):400–409. doi: 10.1097/00005650-198304000-00003. [DOI] [PubMed] [Google Scholar]
  4. Bass M. J., McWhinney I. R., Donner A. Do family physicians need medical assistants to detect and manage hypertension? CMAJ. 1986 Jun 1;134(11):1247–1255. [PMC free article] [PubMed] [Google Scholar]
  5. Dagenais G. R., Robitaille N. M., Lupien P. J., Christen A., Gingras S., Moorjani S., Meyer F., Rochon J. First coronary heart disease event rates in relation to major risk factors: Quebec cardiovascular study. Can J Cardiol. 1990 Sep;6(7):274–280. [PubMed] [Google Scholar]
  6. Diehr P., Williams S. J., Martin D. P., Price K. Ambulatory mental health services utilization in three provider plans. Med Care. 1984 Jan;22(1):1–13. doi: 10.1097/00005650-198401000-00001. [DOI] [PubMed] [Google Scholar]
  7. Dunn E., Hilditch J., Chipman M., Hardacre G., Morrison M. Diagnosis and management of hypertension: the stated practices of family physicians. Can Med Assoc J. 1984 Apr 15;130(8):985–988. [PMC free article] [PubMed] [Google Scholar]
  8. Evans C. E., Haynes R. B., Birkett N. J., Gilbert J. R., Taylor D. W., Sackett D. L., Johnston M. E., Hewson S. A. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA. 1986 Jan 24;255(4):501–504. [PubMed] [Google Scholar]
  9. Gordon T., Kannel W. B. Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. JAMA. 1972 Aug 14;221(7):661–666. [PubMed] [Google Scholar]
  10. Kannel W. B. Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol. 1976 Feb;37(2):269–282. doi: 10.1016/0002-9149(76)90323-4. [DOI] [PubMed] [Google Scholar]
  11. Lichtenstein M. J., Shipley M. J., Rose G. Systolic and diastolic blood pressures as predictors of coronary heart disease mortality in the Whitehall study. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):243–245. doi: 10.1136/bmj.291.6490.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lombard J. H., Hinojosa-Laborde C., Cowley A. W., Jr Hemodynamics and microcirculatory alterations in reduced renal mass hypertension. Hypertension. 1989 Feb;13(2):128–138. doi: 10.1161/01.hyp.13.2.128. [DOI] [PubMed] [Google Scholar]
  13. MacMahon S. Antihypertensive drug treatment: the potential, expected and observed effects on vascular disease. J Hypertens Suppl. 1990 Dec;8(7):S239–S244. [PubMed] [Google Scholar]
  14. MacMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990 Mar 31;335(8692):765–774. doi: 10.1016/0140-6736(90)90878-9. [DOI] [PubMed] [Google Scholar]
  15. Malini P. L., Ambrosioni E., De Divitiis O., Di Somma S., Rosiello G., Trimarco B. Simvastatin versus pravastatin: efficacy and tolerability in patients with primary hypercholesterolemia. Clin Ther. 1991 Jul-Aug;13(4):500–510. [PubMed] [Google Scholar]
  16. Mann K. V., Putnam R. W. Physicians' perceptions of their role in cardiovascular risk reduction. Prev Med. 1989 Jan;18(1):45–58. doi: 10.1016/0091-7435(89)90053-4. [DOI] [PubMed] [Google Scholar]
  17. Marton K. I., Tul V., Sox H. C., Jr Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. Arch Intern Med. 1985 May;145(5):816–821. [PubMed] [Google Scholar]
  18. Putnam R. W., Curry L. Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved? CMAJ. 1989 Apr 1;140(7):806–809. [PMC free article] [PubMed] [Google Scholar]
  19. Robitaille N. M., Dagenais G. R., Rochon J., Lupien P. J. Incidence d'hypertension artérielle dans la région de Québec. Clin Invest Med. 1983;6(1):39–42. [PubMed] [Google Scholar]
  20. Rosser W. W. Using the perception-reality gap to alter prescribing patterns. J Med Educ. 1983 Sep;58(9):728–732. doi: 10.1097/00001888-198309000-00008. [DOI] [PubMed] [Google Scholar]
  21. Sanazaro P. J. Determining physicians' performance. Continuing medical education and other interacting variables. Eval Health Prof. 1983 Jun;6(2):197–210. doi: 10.1177/016327878300600205. [DOI] [PubMed] [Google Scholar]
  22. Stein L. S. Education of residents. JAMA. 1981 Sep 18;246(12):1299–1299. doi: 10.1001/jama.1981.03320120011005. [DOI] [PubMed] [Google Scholar]
  23. Sytkowski P. A., Kannel W. B., D'Agostino R. B. Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med. 1990 Jun 7;322(23):1635–1641. doi: 10.1056/NEJM199006073222304. [DOI] [PubMed] [Google Scholar]
  24. Winickoff R. N., Coltin K. L., Morgan M. M., Buxbaum R. C., Barnett G. O. Improving physician performance through peer comparison feedback. Med Care. 1984 Jun;22(6):527–534. doi: 10.1097/00005650-198406000-00003. [DOI] [PubMed] [Google Scholar]
  25. Wolf P. A., D'Agostino R. B., Belanger A. J., Kannel W. B. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991 Mar;22(3):312–318. doi: 10.1161/01.str.22.3.312. [DOI] [PubMed] [Google Scholar]
  26. Wong E. T., McCarron M. M., Shaw S. T., Jr Ordering of laboratory tests in a teaching hospital. Can it be improved? JAMA. 1983 Jun 10;249(22):3076–3080. [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES