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Decision rules for hypertension screening: application in a poor community with endemic hypertension
Insights
Stricter hypertension clinic admission rules, like increasing the threshold from 140/90 mm Hg to 160/95 mm Hg, significantly reduced patient numbers and costs. However, this approach may increase the risk of serious health events in men.
Area of Science:
- Cardiovascular Health
- Public Health
- Health Services Research
Background:
- Hypertension affects a significant portion of the rural southern Black population.
- Effective management of hypertension requires careful patient selection for clinic treatment.
- Previous studies have not fully evaluated the impact of different admission criteria on clinic resources and patient outcomes.
Purpose of the Study:
- To analyze the impact of various admission-decision rules on the caseload of a proposed hypertension clinic.
- To evaluate the trade-offs between reduced patient load, personnel utilization, drug costs, and potential increases in morbid events.
Main Methods:
- Analysis of data from 4,272 Black residents in a rural southern community.
- Investigation of four admission-decision rules: conjunctive, disjunctive, additive, and systolic only.
- Comparison of outcomes with incremental increases in the minimum blood pressure threshold (140/90 mm Hg to 160/95 mm Hg).
Main Results:
- Increasing the admission threshold from 140/90 mm Hg to 160/95 mm Hg reduced patient numbers by one-third.
- Personnel utilization per patient decreased by 24%, and drug costs by 34%.
- An estimated 14% increase in the attack rate for morbid events was observed in men under the stricter criteria.
Conclusions:
- Admission-decision rules significantly influence hypertension clinic caseloads and resource allocation.
- Stricter blood pressure thresholds for clinic admission can lead to substantial cost savings.
- A potential increase in adverse health events, particularly in men, must be considered when implementing stricter admission criteria.
Abstract:
Data from a hypertension screening project involving 4,272 black residents of a rural southern community were analyzed to determine the effects of a set of admission-decision rules on the case load of a proposed hypertension clinic. Four decision rules were investigated: conjunctive (diastolic high or systolic high); disjunctive (diastolic and/or systolic high); additive (sum of diastolic and systolic high); and systolic only. Most information relevant to admission to treatment came from knowledge of systolic blood pressures, even though knowledge of the diastolic pressure is essential in individual diagnosis. Incremental increases in the minimum blood pressure necessary for admission to treatment from 140/90 mm Hg to 160/95 mm Hg resulted in a one-third reduction in the number of patients treated, a 24% reduction in personnel utilization per patient, and a 34% reduction in drug costs; but in an estimated 14% increase in the attack rate for morbid events in men.