Goldstein C, Hebert P, Horowitz CR, McLaughlin MA, McGinn TG, Sisk JE; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 179.
Mount Sinai Medical Center, Internal Medicine, 1470 Madison Ave., New York, NY 10029 Tel. (212) 241-8528 Fax (212) 831-8116
RESEARCH OBJECTIVE: To determine the role that clinicians knowledge, attitudes, and practices play in poor hypertension control in East and Central Harlem, New York City. Despite proven-effective therapies to control hypertension, 50% or less of treated patients have achieved blood-pressure control at levels recommended by nationalguidelines. This shortfall in the quality of care particularly affects minority patients, such as African-Americans, who have earlier onset and greater prevalence of this chronic condition and disparities in health-related outcomes, such as stroke, renal disease, and cardiac disease. STUDY DESIGN: We surveyed clinicians caring for ambulatory patients at the four hospitals in East and Central Harlem. The survey included four clinical vignettes of hypertensive patients. The blood-pressure values and comorbidities of each scenario remained constant, while patient characteristics such as gender, age, race/ethnicity, occupation, English fluency, and punctuality/reliability in keeping appointments were assigned randomly, so each survey contained a variety of patient characteristics. The analysis relied on guidelines from The NIH Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to assess the appropriateness of clinicians target blood-pressure levels: <140/90 mm Hg for isolated systolic hypertension (ISH) or coronary artery disease (CAD), <130/85 mm Hg for diabetes and <125/75 mm Hg for renal disease. We used a four-point likert scale (1=strongly agree, 4=strongly disagree) to assess clinicians attitudes about the likelihood of each patient's blood-pressure control, adherence, and return for follow-up. Data was analyzed using generalized linear models. POPULATION STUDIED: We surveyed attending physicians, fellows, house officers, and nurse practitioners in internal medicine, geriatrics, and cardiology clinics of each hospital. PRINCIPAL FINDINGS: To date, 180 of an anticipated 300 clinicians have completed surveys, 53% female and 58% house officers. Only 5% of clinicians chose a blood-pressure target for patients with renal disease that was within 2 mm Hg of the guidelines. Clinicians knowledge and self-reported consistency with the evidence-based guidelines were better for the vignettes with diabetes, 86%; ISH, 98%; and CAD, 99% all within 2 mm Hg. Blood-pressure targets did not vary by patient gender, age, race/ethnicity, occupation, or English fluency, or by clinician gender or experience. Clinicians responses concerning the likelihood of patients blood-pressure control, adherence to medications, and return for follow-up also did not differ by patient sociodemographics. However, clincians considered patients who arrived late or missed previous appointments to be less likely to reach blood-pressure goals and to adhere to recommended therapy and follow-up. CONCLUSIONS: Preliminary results suggest that the majority of clinicians caring for hypertensive patients in these clinics follow blood-pressure targets that approximate the national guidelines for patients with ISH, CAD, and diabetes. Self-reported care for patients with renal disease, however, fell far short of the guidelines. Neither clinicians target blood pressures nor their attitudes varied by patient's gender, age, race/ethnicity or occupation. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Improved adherence among clinicians to evidence-based recommendations for renal disease patients may improve the quality of care, blood-pressure control, and health-related outcomes among patients in these communities, especially given the disparity in renal disease among African-Americans.
Publication Types:
Keywords:
- African Americans
- Blood Pressure
- Blood Pressure Determination
- Data Collection
- Diabetes Complications
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- European Continental Ancestry Group
- Female
- Humans
- Hypertension
- Kidney Diseases
- Kidney Failure, Chronic
- New York City
- Prevalence
- Stroke
- hsrmtgs
Other ID:
UI: 102275900
From Meeting Abstracts