Changes in primary care could improve blood pressure results


Operational changes are related to improvements in smoking and blood pressure outcomes in primary care practice settings, new research indicates.

He qualitative analysis, published in the Annals of Family Medicine, included smoking and blood pressure as separate outcome measures.

Results were calculated using improvements in the Clinical Quality Measure, with targets of at least 10 points for absolute improvements in the proportion of patients with smoking screening, where appropriate, counseling, and in the proportion of hypertensive patients with adequately controlled BP. The results were obtained from practices that participated in Evidence-NOW, a multisite cardiovascular disease prevention initiative. Comparative configuration methods were used to evaluate the joint effects of multiple factors on the results.

Most of the analysis practices were medically owned, small (less than six physicians) and / or in an urban location. The researchers sampled and interviewed practice staff from a subset of 104 primary care consultations from 7 cooperatives and 12 states, ranging from small to medium, with 10 or fewer clinicians. Interview data were analyzed to identify operational changes, and then transformed into numerical data.

Operational changes that led to improvements in specific contexts

In physician-owned practices, process improvement, documentation, and referral to resources, combined with a moderate level of facilitation support, led to an improvement of at least 10 points in smoking outcomes.

However, the researchers found that these patterns were not observed in system-owned practices or in federally qualified health centers.

In solo practices, training medical assistants to take accurate blood pressure led to an improvement of at least 10 points in blood pressure results.

Among the greatest practices, property of physicians, the measurement of blood pressure for the second time when the first was raised and the documentation of this reading in the electronic health record, also led to an improvement of 10 points or more in the result of BP when combined with a large amount (50 hours or more) of facilitation.

“There was no magic bullet to improve smoking cessation counseling and blood pressure results in the various primary care practices studied,” lead author Deborah J. Cohen said in an interview. PhD, Oregon Health & Science University, Portland. “Combinations of operational changes between sizes and types of practices led to improvements.”

Smaller practices are more agile, experts say

The results of the qualitative analysis of the data suggest that smaller, medically owned practices are more likely to have the capacity for change and improvement compared to larger hospital / health system practices.

Commenting on the study, Noel Deep, MD, regional medical director of Aspirus Clinics, Ironwood, Michigan, said solitary or small private practices have a clear advantage over larger hospital or system-owned practices when they implement new operational changes to improve clinical outcomes.

“A smaller independent practice is agile, with the doctor [or physicians] able to make a quick decision by analyzing scientific data, planning changes, implementing them quickly, and doing a quick review of the results cycle and modifying the program to achieve goals, ”said Deep, a member of News’s editorial advisory board. of Internal Medicine.

Kate Rowland, MD, MS, assistant professor in the family medicine department at Rush Medical College, Chicago, also noted that smaller practices have unique advantages over larger health care organizations.

“Larger organizations should replicate the benefits of smaller offices, providing as much local decision and autonomy as possible to the place where the changes are taking place,” Rowland explained in an interview.

“Clinicians at these sites are likely to know what will be successful in achieving measurable change in the patients they care for,” he added.

The study was funded by the Agency for Health Research and Quality. The authors and other experts interviewed for this piece reported that they had no conflicts of interest.

This story originally appeared on, which is part of the Medscape professional network.

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