THE MANAGEMENT OF HYPERTENSION - IMPACT O F AN EDUCATIONAL-PROGRAM ONFAMILY PHYSICIANS

OBJECTIVE To evaluate the effectiveness of a program to improve hypert ension control practices in primary care. DESIGN Retrospective quasi-e xperimental study. SETTING Three hospital-based family medicine centre s (FMCs) PARTICIPANTS Two study groups of 100 randomly-selected adult patients each, who visited the study FMC before implementation of the hypertension program (from April 1, 1983 to March 31, 1984) or afterwa rd (from April 1, 1986 to March 31, 1987). These patients were compare d to patients from control FMCs A and B seen during the same time fram es (100 patients before and after at FMC A and 60 at FMC B). INTERVENT IONS 1) Educational sessions for physicians to standardize knowledge o f the recommendations of the Canadian Hypertension Society on hyperten sion treatment and 2) specific operational incentives to improve hyper tension control, including a reference guide placed in each physician' s office, a specific hypertension follow-up form placed with each pati ent's chart, a recall card file, and hypertension information handouts . MAIN OUTCOME MEASURE Blood pressure measurements recorded in patient charts. Hypertension control is determined from the Canadian Hyperten sion Society recommendations. RESULTS The hypertension control rate wa s 52% in the study group before program implementation and 34.3% after ward (p = 0.01); the corresponding rates in the two control groups mov ed from 47.4% to 59.8% (p > 0.05) in Group A and from 40.7% to 39.3% ( p > 0.05) in Group B. Patients listed in the recall card file were not controlled more frequently (33.3%) than those not listed (35.3%). CON CLUSION This intervention did not improve physician practice regarding hypertension control. Clinicians did not follow the protocol as recom mended. Physicians must be convinced that a change in their practice i s needed before any specific strategies are introduced to support the change. Different suggestions and alternatives related to hypertension management are discussed.