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The Mayo Three-Community Hypertension Control Program. III. Outcome in a community-based hypertension clinic
Insights
A rural Community Hypertension Clinic managed by nurse practitioners effectively controlled high blood pressure in patients. This hypertension control program demonstrated significant blood pressure reduction and low dropout rates over two years.
Area of Science:
- Cardiovascular Health
- Public Health Initiatives
- Rural Healthcare Delivery
Background:
- Hypertension control remains a significant public health challenge, particularly in rural settings.
- Community-based programs are essential for improving access to care and managing chronic conditions like hypertension.
- Evaluating innovative healthcare models, such as nurse practitioner-led clinics, is crucial for effective hypertension management.
Purpose of the Study:
- To assess the effectiveness of a Community Hypertension Clinic in a rural area.
- To evaluate hypertension control outcomes and patient adherence in a nurse practitioner-managed setting.
- To compare the outcomes of patients managed at the Community Hypertension Clinic versus those referred to private physicians.
Main Methods:
- A Community Hypertension Clinic was established in a rural community, staffed by nurse practitioners.
- Hypertensive individuals were identified through initial blood pressure screening.
- Patients were offered secondary screening at the Clinic, with management by nurse practitioners, and outcomes were tracked over two years.
Main Results:
- 57% of Clinic patients achieved diastolic blood pressure below 90 mm Hg after two years.
- The Community Hypertension Clinic experienced a low dropout rate of 5% after 30 months.
- Patients with more severe hypertension were more likely to attend the Clinic, and this group showed greater blood pressure declines compared to those seeing private physicians.
Conclusions:
- Community Hypertension Clinics managed by nurse practitioners can effectively control hypertension in rural populations.
- The program demonstrated high patient retention and significant improvements in blood pressure control.
- This model offers a viable approach to improving hypertension management in underserved rural communities.
Abstract:
As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither. After secondary screening at the Clinic, 120 patients eventually came under care and were managed by the nurse practitioners. After 2 years of follow-up, 57% of the Clinic patients had office-recorded diastolic blood pressures of less than 90 mm Hg. The Community Hypertension Clinic dropout rate was only 5% after 30 months of operation, for participants whose duration of follow-up ranged from 12 to 27 months (median 16 months), when a repeat home blood pressure screening examination was performed. Comparison of outcomes was thus possible between persons who attended the Community Hypertension Clinic and those who were referred to their physicians' offices. Persons with more severe hypertension most often elected to go to the Clinic, whereas patients with milder degrees of hypertension tended to go to their private physicians for follow-up or failed to make the recommended second-stage screening contact altogether. Greater declines in blood pressure were observed in the Clinic group.