Key result
More primary care nurse visits linked to ~10% higher odds of blood pressure control.
Why the study?
Hypertension is a major cause of cardiovascular disease and blood pressure is often inadequately treated, prompting an evaluation of how primary health care centre visit patterns relate to individual blood pressure control.
Does a higher proportion of nurse visits at primary health care centers improve blood pressure control in patients with uncomplicated hypertension?
Cross-Sectional (n=88,945)
Yes
Does a higher proportion of nurse visits at primary health care centers improve blood pressure control in patients with uncomplicated hypertension?
Odds Ratio: 1.1 (95% CI 1.01–1.21)
Absolute Event Rate: 64.6% vs 62.3%
Structuring primary care to include more nurse-based team care is associated with higher rates of blood pressure control in patients with uncomplicated hypertension.
Higher nurse visit proportions were associated with better BP control; hypothesis-generating and should not yet change practice.
OBJECTIVE: Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control. DESIGN AND SETTING: Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region. PATIENTS: A total of 88,945 patients with uncomplicated hypertension age 40-79. MAIN OUTCOME MEASURES: Odds ratio (OR) for the individual patient to achieve the BP target of ≤140/90 mmHg. RESULTS: Overall, 63% of patients had BP ≤ 140/90 mmHg (48% BP < 140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32). CONCLUSIONS: In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.
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Ödesjö et al. (2019) conducted a cross-sectional in Uncomplicated hypertension (n=88,945). Nurse-based care (higher proportion of nurse visits) vs. Physician-based care was evaluated on Achieving blood pressure target of ≤140/90 mmHg (OR 1.10, 95% CI 1.01-1.21). Enrollment at primary care centers with a higher proportion of nurse visits was associated with increased odds of achieving blood pressure control ≤140/90 mmHg (OR 1.10, 95% CI 1.01-1.21).
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