| dc.description.abstract | Problem: Hypertension (HTN) affects over a third of all American adults, 20% of which are undiagnosed and untreated. HTN leads to greater morbidity and mortality, placing a person at a significantly greater risk for cardiovascular events and chronic kidney disease. The majority of those 13 million people with undiagnosed HTN visit their healthcare provider two or more times a year. Many patients presenting with elevated blood pressure (BP) measurements in primary care clinics in Kansas City often remain undiagnosed for HTN, which is likely to lead to poorer health outcomes. No facility-specific protocols exist to encourage follow-up in patients at high risk for HTN to address this problem. Project Aim: The aim for this quality improvement (QI) project was to determine the effectiveness of an educational intervention on the rates of diagnosis and treatment of HTN in a primary care clinic in Kansas City. Project Method: This QI project used the plan-do-study-act (PDSA) model to determine if diagnosis of HTN increased after eight weeks of the implementation of an instrument that encouraged follow-up in patients found with a BP of 130/80 or greater. The handout to patients with high BP consisted of four components: (1) brief education related to HTN, (2) lifestyle changes to decrease BP, (3) instructions for obtaining self-measured BPs, and (4) instructions to make a follow-up clinic appointment if their BP remains elevated. Data were gathered to evaluate if there was a reduction in the amount of undiagnosed HTN and in the average BPs of those seen in the clinic after the intervention. The patients included in this project were required to be English-speaking, between the ages 18 and 65, and had to have visited a specific primary care clinic in Olathe, Kansas, between May 20 and August 9, 2019. Findings: A total of 635 patient records were reviewed during the pre- and post-intervention phases. The number of undiagnosed HTN patients before the intervention was 91 of 301 participants, for a total of 30.2%. The number of undiagnosed hypertensive patients after the intervention was 120 of 334 participants, for a total of 35.9%. An estimated 424 patients had undiagnosed HTN during the eight-week intervention period, but only 233 educational handouts were provided. The fact that only 55% of eligible patients received the intervention can be explained by patient refusal and lack of staff consistently offering the handout to eligible patients. There was no improvement in the pre-intervention means of systolic and diastolic BPs to the post-intervention BPs (121.1 mm Hg, 122.3 mm Hg) and (76.3 mm Hg, 78.6 mm Hg) respectively. Conclusion: Primary care providers will frequently observe undiagnosed HTN. Thus, more structured protocols need to be developed to provide more consistent diagnosis and treatment for HTN in order to prevent the long-term consequence of HTN. This DNP project did not demonstrate a statistically significant improvement in BP measurements or the rate of undiagnosed HTN. However, the data indicated a significant proportion of patients seen during the project timeline had undiagnosed HTN, suggesting this is a practice problem at this clinic and future education and assessment of HTN needs to be implemented. | |
