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- Geary, L., et al.
(author)
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An audit & feedback intervention for improved anticoagulant use in patients with atrial fibrillation in primary care
- 2020
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In: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 310, s. 67-72
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Journal article (peer-reviewed)abstract
- Background: Improving use of anticoagulants in atrial fibrillation (AF) patients in primary care has proved challenging. Anticoagulants are often prescribed by primary care physicians in the long term. Suboptimal anticoagulant use may be partly due to physicians' non-prescribing. One potential way of targeting physician prescribing behavior is “audit & feedback”. The documented use of audit and feedback in research aimed at increasing use of anticoagulants in primary care is limited. The objective was to test if an audit & feedback intervention aimed at directors in primary care centers could increase the use of anticoagulants in patients with AF.Methods: Database generated quality reports with primary care center specific data on recommended medication use in their patients with previous stroke or atrial fibrillation were sent to intervention centers.Results: 94 centers received the intervention, 102 centers were controls. 31,477 patients in total were included. Use of anticoagulants in all primary care centers increased from 76% before to 82% after the intervention. Patients in intervention centers were more likely than patients in control centers to use anticoagulants after the intervention, adjusted odds ratio increasing slightly from 1.04 (95%, CI, 0.98–1.10) before to 1.08 (95% CI, 1.02–1.15) after the intervention.Conclusions: An audit & feedback intervention with quality reports in primary care had only a small effect on anticoagulant use in patients with AF. A combined and more complex intervention may have a greater effect in improving anticoagulation use.
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- Qvarnström, Miriam, et al.
(author)
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Antihypertensive treatment and control in a large primary care population of 21 167 patients
- 2011
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In: Journal of Human Hypertension. - London, UK : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 25:8, s. 484-491
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Journal article (peer-reviewed)abstract
- The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure <140/90mmHg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary health-care centres, with a combined registered population of 330 000 subjects. We included all patients >= 30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n = 21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure <140/90mmHg. The number of prescribed drugs increased with age, except among the oldest (>= 90 years). Only 29% of patients given monotherapy had a blood pressure <140/90mmHg. Women more often received diuretics (52 vs 42%), and less often angiotensin-converting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. beta-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control. Journal of Human Hypertension (2011) 25, 484-491; doi: 10.1038/jhh.2010.86; published online 19 August 2010
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- Rasjö Wrååk, G., et al.
(author)
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Nurse-led empowerment strategies for patients with hypertension : A questionnaire survey
- 2015
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In: International Nursing Review. - : Wiley. - 0020-8132 .- 1466-7657. ; 62:2, s. 187-195
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Journal article (peer-reviewed)abstract
- Background: Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim: This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods: A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results: Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations: Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion: Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. Implications for nursing and health policy: This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.
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