Use of management-by-objective for the case finding and treatment of hypertension

A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve the detection and quality of treatment of hypertension in 20 family practices in Ashdod, Israel. The number of hypertensive patients in each practice was estimated from the age-sex register and this was compared with the actual number. The combined prevalence in the 20 practices was only 20.8% of the expected prevalence, and of those treated the blood pressure of 29.6% was not under control (diastolic pressure 95 mmHg or over). The practice teams committed themselves to improving the detection of hypertension by active case finding. Once every six months for three years the health care consultant reviewed the results of detection and treatment with each team. After three years the number of hypertensive patients had increased from 977 patients (20.8% of expected prevalence) to 2914 patients (62.1%) - a three-fold increase. The percentage of treated patients whose blood pressure was not under control (diastolic pressure 95 mmHg or over) did not change substantially (from 29.6% to 27.9%). A management-by-objective approach, when accompanied by regular feedback, appears to motivate primary care teams to improve the detection of hypertension in their patients.