EFFECTIVENESS OF A PROGRAM TO IMPROVE HYPERTENSION SCREENING IN PRIMARY-CARE

Objective: To evaluate the effectiveness of a program to improve hyper tension screening practices in primary care. Design: Retrospective qua si-experimental study. Setting: Two hospital-based family medicine cen tres (FMCs). Patients: In the study FMC, two study groups of randomly selected adult patients: 425 who visited the FMC before implementation of the screening improvement program (from Apr. 1, 1983, to Mar, 31, 1984) and 418 who visited it afterward (from Apr. 1, 1986, to Mar. 31, 1987). These patients were matched with 392 and 442 control patients respectively seen during the same time frames at the second FMC. Inter ventions: Educational sessions for physicians to standardize blood pre ssure measurement and knowledge of the recommendations from the Canadi an Hypertension Society on hypertension screening and diagnosis, and s pecific operational incentives to improve hypertension screening, incl uding a reference guide placed in each physician's office, a coloured form for recording blood pressure measurements placed in every patient 's chart and a followup and recall card file. Main outcome measure: Fr equency of blood pressure measurements recorded in patient charts. Res ults: The hypertension screening rate was 60% per year in the study gr oup before program implementation and 79% in the study group afterward ; the corresponding rates in the two control groups were 72% and 59% ( p < 0.0001). Patients were more likely to be screened if they visited the physician for a periodic health examination than for other problem s (e.g., psychosocial or dermatologic) and if they had a scheduled app ointment rather than no appointment. Physician characteristics that we re positive predictors of screening were low age, female sex and payme nt on a salary basis. Conclusion: Physician education and incentives a re effective in improving hypertension screening practices in hospital -based FMCs without incurring additional costs or other use of resourc es. Further evaluation of such a program should be undertaken in other primary care settings,