Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | General Medicine | Research article

Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study

Authors: Nida Buawangpong, Kanokporn Pinyopornpanish, Wichuda Jiraporncharoen, Nisachol Dejkriengkraikul, Pakorn Sagulkoo, Chanapat Pateekhum, Chaisiri Angkurawaranon

Published in: BMC Primary Care | Issue 1/2020

Login to get access

Abstract

Background

Treating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care.

Methods

A retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher’s exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder.

Results

The evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p <  0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004).

Conclusions

Adopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand.
Appendix
Available only for authorised users
Literature
1.
2.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441.PubMedPubMedCentral
3.
Bittner DO, Klinghammer L, Marwan M, Schmid J, Layritz C, Hoffmann U, et al. Influence of cardiovascular risk factors on the prevalence of coronary atherosclerosis in patients with angiographically normal coronary arteries. Acad Radiol. 2017;24(5):580–6.
4.
Phrommintikul A, Krittayaphong R, Wongcharoen W, Yamwong S, Boonyaratavej S, Kunjara-Na-Ayudhya R, et al. Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study. Singap Med J. 2017;58(9):535–42.
5.
Chan SC, Chandramani T, Chen TY, Chong KN, Harbaksh S, Lee TW, et al. Audit of hypertension in general practice. Med J Malays. 2005;60(4):475–82.
6.
Hiremath JS, Katekhaye VM, Chamle VS, Jain RM, Bhargava AI. Current practice of hypertension in India: focus on blood pressure goals. J Clin Diagn Res. 2016;10(12):25–8.
7.
Mbui JM, Oluka MN, Guantai EM, Sinei KA, Achieng L, Baker A, et al. Prescription patterns and adequacy of blood pressure control among adult hypertensive patients in Kenya; findings and implications. Expert Rev Clin Pharmacol. 2017;10(11):1263–71.PubMed
8.
Ahmad N, Hassan Y, Tangiisuran B, Meng OL, Abd Aziz N, Ahmad FU, et al. Guidelines adherence and hypertension control at a tertiary hospital in Malaysia. J Eval Clin Pract. 2013;19(5):798–804.PubMed
9.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet (London, England). 2016;387(10022):957–67.
10.
11.
Barth JH, Misra S, Aakre KM, Langlois MR, Watine J, Twomey PJ, et al. Why are clinical practice guidelines not followed? Clin Chem Lab Med. 2016;54(7):1133–9.PubMed
12.
Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600–7.
13.
American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5–26.
14.
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and Management of High Blood Pressure in adults. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines 2017:24430.
15.
Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine: transforming the clinical method. 2nd ed; 2003.
16.
Ontario HQ. Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis. Ontario Health Technol Assessment Series. 2013;13(6):1–41.
17.
Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: does satisfaction with doctor-patient relationship work? J Res Med Sci. 2017;22:48.PubMedPubMedCentral
18.
Bernheim SM, Ross JS, Krumholz HM, Bradley EH. Influence of patients' socioeconomic status on clinical management decisions: a qualitative study. Ann Fam Med. 2008;6(1):53–9.PubMedPubMedCentral
19.
Arpey NC, Gaglioti AH, Rosenbaum ME. How socioeconomic status affects patient perceptions of health care: A qualitative study. J Prim Care Community Health. 2017;8(3):169–75.PubMedPubMedCentral
20.
21.
Flynn SJ, Ameling JM, Hill-Briggs F, Wolff JLBL, Levine DM, Roter DL, et al. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient Prefer Adherence. 2013;7:741–9.PubMedPubMedCentral
22.
Gottdiener JS, Reda DJ, Materson BJ, Massie BM, Notargiacomo A, Hamburger RJ, et al. Importance of obesity, race and age to the cardiac structural and functional effects of hypertension. The Department of Veterans Affairs Cooperative Study Group on antihypertensive agents. J Am Coll Cardiol. 1994;24(6):1492–8.PubMed
23.
Colecraft EK, Asante M, Christian AK, Adu-Afarwuah S. Sociodemographic characteristics, dietary practices, and nutritional status of adults with hypertension in a semi-rural community in the Eastern region of Ghana. Int J Hypertens. 2018;2018:2815193.
24.
Wu X, Li B, Lin WQ, Huang LL, Wang XX, Fu LY, et al. The association between obesity indices and hypertension: Which index is the most notable indicator of hypertension in different age groups stratified by sex? Clin Exp Hypertens. 2019;41(4):373–80.
25.
Vathesatogkit P, Woodward M, Tanomsup S, Ratanachaiwong W, Vanavanan S, Yamwong S, et al. Cohort profile: the electricity generating authority of Thailand study. Int J Epidemiol. 2011;41(2):359–65.PubMed
26.
Ridtidat R, Komanasin N. Mogkolwongroj P. Assessment of cardiovascular disease risk by the Rama-EGAT heart score in staff of Songkhla hospital. J Med Tech Phy Ther. 2015;27(1):14–27.
27.
Supina P, Harncharoen K, Siri S, Maneesia A. Rama – EGAT heart score validity among acute coronary syndromes patients in Siriraj hospital. J Nurs Sci S1. 2009;27:77–82.
28.
Clinical Practice Guideline on Pharmacologic Therapy of Dyslipidemia for Atherosclerotic Cardiovascular Disease Prevention. In: The Royal College of Physicians of Thailand, editor. 2016.
29.
Matthys E, Remmen R, Bogaert PV. An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care? BMC Fam Pract. 2017;18(1):110.PubMedPubMedCentral
30.
31.
Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.PubMed
32.
Lee King PA, Cederbaum JA, Kurzban S, Norton T, Palmer SC, Coyne JC. Role of patient treatment beliefs and provider characteristics in establishing patient–provider relationships. Fam Pract. 2015;32(2):224–31.PubMedPubMedCentral
33.
Adedapo AD, Akunne OO, Oladapo OO, Salako BL. Drug utilization and blood pressure control in ambulatory hypertensive patients: focus on those with compelling indications. Int J Clin Pharmacol Ther. 2017;55(3):237–45.PubMed
34.
de Silva D. Helping measure person-centred care: A review of evidence about commonly used approaches and tools used to help measure person-centred care. London: The Health Foundation; 2014.
35.
Ekman I, Wolf A, Olsson LE, Taft C, Dudas K, Schaufelberger M, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J. 2012;33(9):1112–9.PubMed
36.
Cropley S. The relationship-based care model: evaluation of the impact on patient satisfaction, length of stay, and readmission rates. J Nurs Administration. 2012;42(6):333–9.
Metadata
Title
Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study
Authors
Nida Buawangpong
Kanokporn Pinyopornpanish
Wichuda Jiraporncharoen
Nisachol Dejkriengkraikul
Pakorn Sagulkoo
Chanapat Pateekhum
Chaisiri Angkurawaranon
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-020-01183-0

Other articles of this Issue 1/2020

BMC Primary Care 1/2020 Go to the issue

Research article

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Research article

Transitioning to Aboriginal community control of primary health care: the process and strategies of one community-controlled health organisation in Queensland

Research article

Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement

Research article

Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

Correction

Correction to: Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

Research article

Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom