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Team-based hypertension management effective in primary care

A team-based approach, including a physician, registered nurse and health technician, was effective in managing BP among patients with hypertension, and can provide a framework for the implementation of such care in the patient-centered home, according to data published in the Journal of Primary Care and Community Health.

“Adequate treatment for hypertension requires not only compliance with pharmacologic treatment, but also a multimodal approach, including dietary changes, weight loss, exercise, smoking cessation and reduced alcohol consumption,” Jeffrey D. Kravetz, MD, and Robert F. Walsh, MHA, both of the U.S. Veterans Affairs (VA) Connecticut Health Care System, in West Haven, wrote. “… The patient-centered medical home involves a team-based approach to patient care, and is becoming the standard of care in primary care. In April 2010, the Department of Veterans Affairs implemented a patient-centered medical home (PCMH) through the creation of patient aligned care teams (PACT), consisting of a physician, registered nurse and health technician. This approach allows for more opportunities for patient care, since multiple team members at various levels of training can respond to patient needs and also proactively address preventive health care.”

To measure the effectiveness of the team-based model within a PACT in managing hypertension in primary care, the researchers recruited 665 patients, with a BP of more than 160/100 mm Hg, from two primary care clinics within the West Haven VA Medical Center, in Connecticut in a pilot study.

The 350 patients included in the intervention clinic were contacted by the primary care team and offered multiple treatments aimed at improving BP control, including discussions of medication compliance, medication titration, home BP monitoring, nutritional counseling and motivational interviews. The 315 patients in the second clinic received usual primary care. The change in BP in the patients in the intervention group at 4 months was compared with that of patients in the control clinic.

According to the researchers, the decrease in systolic BP at 4 months in the intervention group was significantly greater than in the usual care group (15.6 mm Hg vs. 9.9 mm Hg; P < .001). In the intervention clinic, 62% of patients had lower systolic BP following treatment, compared with 41% among patients who received the usual primary care (P < .001). Reduction in diastolic BP occurred in 54% of intervention patients, compared with 37% of usual care patients (P < .001).

“Even when excluding patients with antihypertensive medication changes, we were still able to demonstrate greater [BP] control with a team-based approach to treatment,” Kravetz and Walsh wrote. “Using multiple members of a PACT to manage chronic diseases not only has the chance to improve patient outcomes, but also empowers other members of the PACT to provide better care.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.