Why the study?
Most patients with antihypertensive medication fail to achieve blood pressure targets due to patient non-adherence and clinician non-adherence to guidelines. This study evaluated whether a checklist could improve care quality and reduce non-adherence when initiating antihypertensive medication.
Does a 9-item checklist improve the setting and recall of blood pressure targets in patients initiating antihypertensive medication in primary care?
Does a 9-item checklist improve the setting and recall of blood pressure targets in patients initiating antihypertensive medication in primary care?
The use of a checklist during the initiation of antihypertensive medication significantly improves the setting of adequate BP targets and patient recall of these targets in primary care.
Answers are grounded in this paper and cite their sources.
Supports checklist use at antihypertensive initiation in primary care; extends evidence for implementation tools in hypertension.
BACKGROUND: Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence. METHODS: The study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30-75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol. RESULTS: In total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention. CONCLUSIONS: Even highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem. TRIAL REGISTRATION: NCT02377960 . Date of registration: February 26th, 2015.
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Tahkola et al. (2018) studied this question.
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