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A national programme of hypertension control using a doctor-nurse team approach: the Israel experience
D S Silverberg1, L Baltuch, Y Hermoni
1Medical Division, Kupat Holim of the Histadrut (Health Insurance Institution of the General Federation of Labour), Tel Aviv, Israel.
Insights
Implementing a team approach with nurses and physicians significantly improved hypertension management in Israel. This intervention increased treatment control rates and drastically reduced patient drop-out rates.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Healthcare Management
Background:
- Early 1970s studies in Israel revealed low hypertension treatment and control rates.
- Significant patient drop-out rates (around 30%) were observed in existing hypertension management programs.
Purpose of the Study:
- To enhance the detection and treatment of hypertension.
- To improve patient adherence and control rates through a collaborative healthcare model.
Main Methods:
- A team approach involving nurses and family physicians was implemented in Kupat Holim family clinics.
- Key strategies included an improved appointment system, active case-finding, follow-up for drop-outs, enhanced documentation, and health education.
- Annual reports were submitted to a central registry for data tabulation and feedback.
Main Results:
- By December 1983, 729 family practices (35.7%) participated, treating 46,909 patients.
- Hypertension control rates improved significantly, with about three-quarters of treated men and women achieving target diastolic blood pressure (< 95 mmHg).
- The patient drop-out rate decreased to 2.1%, and average waiting time reduced from 105 to 7 minutes.
Conclusions:
- The collaborative team approach effectively improved hypertension detection, treatment, and control in primary care settings.
- This model demonstrated a substantial reduction in patient drop-out rates and waiting times, enhancing healthcare efficiency.
- The findings underscore the importance of integrated care strategies for managing chronic conditions like hypertension.
Abstract:
Studies in Israel in the early 1970s showed that only about one-quarter of the men and half of the women with hypertension were on treatment and only about one-quarter of the treated males and half of the treated females were under control (diastolic blood pressure < 95 mmHg). Drop-out rate averaged about 30%. To improve detection and treatment of hypertension the nurses in the family clinics of Kupat Holim were taught to work with the family physicians in a team approach. This included a more efficient appointment system, case-finding, an active follow-up system for drop-outs, better documentation of findings and active health education. Reports are sent annually to a central registry in Tel Aviv. Results are tabulated and returned to the teams. Up to December 1983, 729 family practices (35.7% of the total number) were participating, and 46,909 patients are currently under treatment. This represents about half of the expected number of hypertensives in these practices. About three-quarters of the treated men and women are under control (diastolic blood pressure < 95 mmHg). Drop-out rate has fallen to 2.1% and waiting time from 105 to 7 min.