 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Mary Ann McLaughlin, MD, MPH, Paul L Hebert, PhD, Leah Tuzzio, MPH, Carol R Horowitz, MD, MPH, and Jane E. Sisk, PhD. Health Policy, Mount Sinai School of Medicine, 1425 Madison Ave, New York, NY 10029
BACKGROUND: Uncontrolled hypertension is associated with disparities in health-related outcomes among minority populations. Despite the existence of proven-effective therapies, blood pressure (BP) remains uncontrolled in most treated people. To design an intervention likely to be effective, we wished to identify the specific local problems underlying lack of control.
METHODS: We reviewed charts of 99 consecutive African-American and Latino patients who had next-day appointments in general-medicine, geriatrics, hypertension, and cardiology clinics at the four hospitals in East and Central Harlem; who were treated for ³6 months; and whose most recent BP exceeded national guidelines.
RESULTS: In 624 encounters with BPs recorded during the prior year, patients averaged 6.3 (SD3.1) encounters, 4.1 (SD2.7) after the first with an uncontrolled BP. BP exceeded targets on 87.4% of these subsequent encounters. Clinicians' notes acknowledge elevated BP in 58.9% of these visits, but erroneously commented BP was controlled in 11.3%. When clinicians acknowledged the elevated pressures, they changed medications in 34.7% of visits, documented lack of patient medication adherence in 17.0%, and counseled lifestyle modifications in 4.5%.
DISCUSSION: Patients' uncontrolled BPs persisted despite multiple contacts with clinical care. When clinicians acknowledged elevated pressures, they often did not change medication or other management. A nurse manager who interacts with patients and clinicians may ameliorate these problems. We are evaluating nurse management to improve BP control in a randomized controlled trial. The results may be generalizable to other inner-city minority populations.
Learning Objectives:
Keywords: Nurses, Health Disparities
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.