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Blood pressure control rates measured in specialty vs primary care practices within a large integrated health system
Sarah J Billups1, Joseph J Saseen1,2, Joseph P Vande Griend1,3
1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
Insights
Blood pressure control is less likely in specialty settings compared to primary care. This finding suggests a need to re-evaluate blood pressure measurement practices in non-hypertension management specialty clinics.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Measurement
Background:
- Hypertension management is crucial for reducing cardiovascular risk.
- Accurate blood pressure measurement is fundamental for effective hypertension assessment and management.
- Clinical observations suggest potential variations in blood pressure control based on the measurement setting.
Purpose of the Study:
- To determine if blood pressure control rates differ between primary care and specialty care settings.
- To analyze the impact of the assessment environment on hypertension management outcomes.
- To provide evidence for optimizing blood pressure measurement strategies within healthcare systems.
Main Methods:
- Retrospective analysis of outpatient blood pressure measurements from 2016 within a large academic accountable care organization.
- Categorization of 86,512 patient measurements into primary care or specialty settings.
- Comparison of blood pressure control rates (<140/90 mmHg) between the two settings, including analyses of patients with measurements in both settings.
Main Results:
- Patients with their most recent blood pressure measurement in a specialty setting (63% controlled) were less likely to achieve control compared to those measured in primary care (68% controlled).
- For patients with measurements in both settings, specialty care measurements showed significantly lower control rates (63%) versus primary care (71%).
- Even when measurements were taken within 7 or 30 days of each other, specialty settings demonstrated lower odds of blood pressure control.
Conclusions:
- Blood pressure control rates are demonstrably lower when the most recent measurement is taken in a specialty care setting versus primary care.
- Healthcare systems should critically assess the utility and potential drawbacks of performing blood pressure measurements in specialty clinics not focused on hypertension management.
- Consideration of resource allocation and the risk of inaccurate readings is essential when deciding on blood pressure measurement locations.
Abstract:
Blood pressure measurement is a diagnostic test and a key component of assessing and managing hypertension, a major contributor to cardiovascular risk. Based on real-world clinical observations within a large, university-based, accountable care organization, we sought to assess whether blood pressure control results varied by the assessment setting, primary care versus specialty. We studied the most recent outpatient measurement for patients with hypertension during the 2016 calendar year and categorized each as being performed in a primary care or specialty setting, and as being controlled (<140/90 mm Hg) or uncontrolled. Among the 86 512 patients identified, the 43 364 whose most recent blood pressure measurement was in a specialty setting were significantly less likely to be controlled compared to the 43 148 whose most recent measurement was in primary care (63% vs 68%, respectively, OR = 0.83 [0.80-0.85]). For the 27 955 patients who had measurements performed in both settings during the year, the control rates based upon their most recent specialty and primary care measurements were 63% and 71%, respectively (OR = 0.62, 0.60-0.65). For the subsets of patients whose measurements in each setting were within 30 or within seven days of each other, the odds of control in the specialty versus primary care setting were 0.63 (0.58-0.75) and 0.65 (0.57-0.75), respectively. Health systems should weigh the value of performing blood pressure measurement in specialty settings that do not manage this condition, taking into consideration the resources required to perform it and the potential negative consequences of inaccurate measurements.
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