Implementing effective hypertension quality improvement strategies: barriers and potential solutions

Abstract

Many quality improvement strategies have focused on improving blood pressure control, and these strategies can target the patient, the provider, and/or the system. Strategies that seem to have the biggest effect on blood pressure outcomes are team change, patient education, facilitated relay of clinical information, and promotion of self-management. Barriers to effective blood pressure control can affect the patient, the physician, the system, and/or "cues to action."We review the barriers to achieving blood pressure control and describe current and potential creative strategies for optimizing blood pressure control. These include home-based disease management, combined patient and provider education, and automatic decision support systems. Future research must address which components of quality improvement interventions are most successful in achieving blood pressure control.

Figure

A Systems Model of Clinical Preventive Care: a model whereby patients and physicians are affected by predisposing, enabling, and reinforcing factors. Each of them is also influenced by the system and by various cues to action. Together, the patient and the physician interact to achieve the desired result, in this case, well controlled blood pressure. Reprinted with Permission from Walsh and McPhee. ¹⁸