A Review of Effective Systems-level Interventions for High Blood Pressure and High Blood Cholesterol Control and Prevention in Healthcare Settings

Objective: To review the literature and determine which policy, environmental or systems-level (PES) interventions in healthcare settings improve clinical outcomes for high blood pressure (HBP) and high blood cholesterol (HBC).

Methods: The ABI/Inform, Lexis/Nexis, Medline, OVID, and PubMed databases were searched for studies published between January 1992 and December 2007 that: 1) occurred in healthcare settings; 2) addressed PES interventions; 3) used experimental, quasi-experimental, or non-experimental designs; 4) were peer-reviewed, and 5) reported clinical outcome measures for HBP or HBC. Of the 644 studies, 89 met all inclusion criteria for HBP only (n=55), HBC only (n=17), or both HBP and HBC(n=17). Data were synthesized by topic, type of intervention, strength of study design, and associations of PES interventions with HBP and HBC outcomes. Studies that showed statistically significant improvements in outcomes between intervention and control groups were ranked positive, and received a “gold standard” rating if the interventions achieved the blood pressure goal(<140/90 mm Hg) and/or the cholesterol goal (<100 mg/dL LDL CHL). Results: The data suggest the following PES components improve HBP and HBC control: 1) standardized treatment and prevention protocols or algorithms (N =31), 2) specialized clinics for HBP and/or HBC management (N=8) 3)multidisciplinary care teams (N=17), 4) provider and patient education (N=24), 5) electronic (N=12) and non-electronic (N=2) systems including reminders, information management, and patient monitoring systems.

Conclusions: The results of our review suggest that comprehensive PES interventions in healthcare settings can be effective for improving control of high blood pressure and high blood cholesterol.