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Visit patterns at primary care centres and individual blood pressure level - a cross-sectional study

Journal article
Authors Helena Ödesjö
Samuel Adamsson Eryd
S. Franzen
Per Hjerpe
Karin Manhem
Annika Rosengren
Jörgen Thorn
S. Bjorck
Published in Scandinavian Journal of Primary Health Care
Volume 37
Issue 1
Pages 53-59
ISSN 0281-3432
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 53-59
Language en
Links dx.doi.org/10.1080/02813432.2019.15...
Keywords Blood pressure, hypertension, nurse, primary health care, Sweden, quality improvement strategies, hypertension, management, barriers
Subject categories Public Health, Global Health, Social Medicine and Epidemiology

Abstract

Objective: Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control. Design and setting: Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region. Patients: A total of 88,945 patients with uncomplicated hypertension age 40-79. Main outcome measures: Odds ratio (OR) for the individual patient to achieve the BP target of <= 140/90 mmHg. Results: Overall, 63% of patients had BP <= 140/90 mmHg (48% BP < 140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32). Conclusions: In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.

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