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Healthy Skepticism Library item: 7715

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Walsh JM, McDonald KM, Shojania KG, Sundaram V, Nayak S, Lewis R, Owens DK, Goldstein MK.
Quality improvement strategies for hypertension management: a systematic review.
Med Care 2006 Jul; 44:(7):646-57
http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00005650-200607000-00006


Abstract:

BACKGROUND: Care remains suboptimal for many patients with hypertension.

PURPOSE: The purpose of this study was to assess the effectiveness of quality improvement (QI) strategies in lowering blood pressure.

DATA SOURCES: MEDLINE, Cochrane databases, and article bibliographies were searched for this study.

STUDY SELECTION: Trials, controlled before-after studies, and interrupted time series evaluating QI interventions targeting hypertension control and reporting blood pressure outcomes were studied.

DATA EXTRACTION: Two reviewers abstracted data and classified QI strategies into categories: provider education, provider reminders, facilitated relay of clinical information, patient education, self-management, patient reminders, audit and feedback, team change, or financial incentives were extracted.

DATA SYNTHESIS: Forty-four articles reporting 57 comparisons underwent quantitative analysis. Patients in the intervention groups experienced median reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) that were 4.5 mm Hg (interquartile range [IQR]: 1.5 to 11.0) and 2.1 mm Hg (IQR: -0.2 to 5.0) greater than observed for control patients. Median increases in the percentage of individuals achieving target goals for SBP and DBP were 16.2% (IQR: 10.3 to 32.2) and 6.0% (IQR: 1.5 to 17.5). Interventions that included team change as a QI strategy were associated with the largest reductions in blood pressure outcomes. All team change studies included assignment of some responsibilities to a health professional other than the patient’s physician.

LIMITATIONS: Not all QI strategies have been assessed equally, which limits the power to compare differences in effects between strategies.

CONCLUSION: QI strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient’s physician was associated with substantial improvement. Future research should examine the contributions of individual QI strategies and their relative costs.

Keywords:
Publication Types: Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S. Review MeSH Terms: Blood Pressure Determination Clinical Trials Education, Continuing/methods Education, Continuing/organization & administration Humans Hypertension/therapy* Knowledge of Results (Psychology) Medical Audit Patient Care Team/organization & administration Patient Education/methods Patient Education/organization & administration Quality Assurance, Health Care/methods* Reminder Systems

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909