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BMC Primary Care
Published in: BMC Primary Care 1/2024

Open Access 01-12-2024 | Hypertension | Research

Quality of care in patients with hypertension: a retrospective cohort study of primary care routine data in Germany

Authors: Christoph Strumann, Nicola J. Engler, Wolfgang C. G. von Meissner, Paul-Georg Blickle, Jost Steinhäuser

Published in: BMC Primary Care | Issue 1/2024

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Abstract

Background

Hypertension is a leading cause of morbidity and mortality if not properly managed. Primary care has a major impact on these outcomes if its strengths, such as continuity of care, are deployed wisely. The analysis aimed to evaluate the quality of care for newly diagnosed hypertension in routine primary care data.

Methods

In the retrospective cohort study, routine data (from 2016 to 2022) from eight primary care practices in Germany were exported in anonymized form directly from the electronic health record (EHR) systems and processed for this analysis. The analysis focused on five established quality indicators for the care of patients who have been recently diagnosed with hypertension.

Results

A total of 30,691 patients were treated in the participating practices, 2,507 of whom have recently been diagnosed with hypertension. Prior to the pandemic outbreak, 19% of hypertensive patients had blood pressure above 140/90 mmHg and 68% received drug therapy (n = 1,372). After the pandemic outbreak, the proportion of patients with measured blood pressure increased from 63 to 87%, while the other four indicators remained relatively stable. Up to 80% of the total variation of the quality indicators could be explained by individual practices.

Conclusion

For the majority of patients, diagnostic procedures are not used to the extent recommended by guidelines. The analysis showed that quality indicators for outpatient care could be mapped onto the basis of routine data. The results could easily be reported to the practices in order to optimize the quality of care.
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Literature
1.
Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–80.CrossRef
2.
Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT, He H, Chen J, Whelton PK, He J. Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis. JAMA Cardiol. 2017;2(7):775–81.PubMedPubMedCentralCrossRef
3.
Roth GA, Mensah GA, Fuster V. The Global Burden of Cardiovascular Diseases and Risks: A Compass for Global Action. J Am Coll Cardiol. 2020;76(25):2980–1.PubMedCrossRef
4.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.PubMedPubMedCentralCrossRef
5.
Gaziano TA, Bitton A, Anand S, Weinstein MC. The global cost of nonoptimal blood pressure. J Hypertens. 2009;27(7):1472–7.PubMedCrossRef
6.
World Health Organization: Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health services. 2018.
7.
Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich DT, Lindblad AJ, Vandermeer B, Allan GM. What are the most common conditions in primary care? Syst Rev Can Fam Phys. 2018;64(11):832–40.
8.
Jessica K, Joey T, Christina SK, Michael RK, Allan GM, Scott G. Who provides chronic disease management? Can Fam Physician. 2023;69(6): e127.CrossRef
9.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.PubMedCrossRef
10.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.PubMedCrossRef
11.
Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Forciea MA, Frishman WH, Jaigobin C, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011;123(21):2434–506.PubMedCrossRef
12.
Ludt S, Angelow A, Baum E: S3-Leitlinien Hausärztliche Risikoberatung zur kardiovaskulären Prävention, AWMF-Register-Nr. 053–024 DEGAM-Leitlinie Nr. 19. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin eV 2017.
13.
Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, Soumerai SB. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ. 2011;342: d108.PubMedPubMedCentralCrossRef
14.
Szecsenyi J, Stock J, Chenot R, Broge B. QISA – Das Qualitätsindikatorensystem für die ambulante Versorgung. Gesundheits- und Sozialpolitik (G&S). 2010;64(1):52–8.CrossRef
15.
Jeitler K, Semlitsch T, Chenot R, Willms G, Szecsenyi J: Qualitätsindikatoren für die Versorgung von Patientinnen und Patienten mit Bluthochdruck. QISA Band C3. Berlin: KomPart; 2020.
16.
Hauswaldt J, Kempter V, Himmel W, Hummers E. Hindernisse bei der sekundären Nutzung hausärztlicher Routinedaten. Gesundheitswesen. 2018;80(11):987–93.PubMedCrossRef
17.
Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Syst Transit. 2020;22(6):i–273.
18.
Wewetzer L, Hauschild S, Blickle P, Hellbrück H, Steinhäuser J. Interoperabilität, Schnittstellen …? Z Allgemeinmed. 2021;97(11):464–70.
19.
Strumann C, Blickle P-G, von Meißner WCG, Steinhäuser J. The use of routine data from primary care practices in Germany to analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus. BMC Prim Care. 2022;23(1):327.PubMedPubMedCentralCrossRef
20.
Schäfer I, von Leitner EC, Schön G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS ONE. 2010;5(12): e15941.ADSPubMedPubMedCentralCrossRef
21.
22.
Thomopoulos C, Parati G, Zanchetti A: Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials. J Hypertens 2016;34(4).
23.
Thomopoulos C, Parati G, Zanchetti A: Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events – meta-analyses of randomized trials. J Hypertens 2016;34(8).
24.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.PubMedCrossRef
25.
Weber T, Amar J, de Backer T, Burkard T, van der Giet M, Gosse P, Januszewicz A, Kahan T, Mancia G, Mayer CC, et al. Covid-19 associated reduction in hypertension-related diagnostic and therapeutic procedures in Excellence Centers of the European Society of Hypertension. Blood Press. 2022;31(1):71–9.PubMedCrossRef
26.
Wynants L, Timmerman D, Bourne T, Van Huffel S, Van Calster B. Screening for data clustering in multicenter studies: the residual intraclass correlation. BMC Med Res Methodol. 2013;13(1):128.PubMedPubMedCentralCrossRef
27.
28.
Sarganas G, Neuhauser HK. The persisting gender gap in hypertension management and control in Germany: 1998 and 2008–2011. Hypertens Res. 2016;39(6):457–66.PubMedCrossRef
29.
Neuhauser H, Diederichs C, Boeing H, Felix SB, Jünger C, Lorbeer R, Meisinger C, Peters A, Völzke H, Weikert C, et al. Hypertension in Germany. Dtsch Arztebl International. 2016;113(48):809–15.PubMedPubMedCentral
30.
Zuin M, Rigatelli G, Zuliani G, Rigatelli A, Mazza A, Roncon L. Arterial hypertension and risk of death in patients with COVID-19 infection: Systematic review and meta-analysis. J Infect. 2020;81(1):e84–6.PubMedPubMedCentralCrossRef
31.
Mattioli AV, Sciomer S, Cocchi C, Maffei S, Gallina S. Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease. Nutr Metab Cardiovasc Dis. 2020;30(9):1409–17.PubMedPubMedCentralCrossRef
32.
Zhang D, Tang X, Shen P, Si Y, Liu X, Xu Z, Wu J, Zhang J, Lu P, Lin H, et al. Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study. BMJ Open. 2019;9(3): e024476.PubMedPubMedCentralCrossRef
33.
Xie H, Li J, Zhu X, Li J, Yin J, Ma T, Luo Y, He L, Bai Y, Zhang G, et al. Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank. Cardiovasc Diabetol. 2022;21(1):199.PubMedPubMedCentralCrossRef
34.
Dragano N, Reuter M, Peters A, Engels M, Schmidt B, Greiser KH, Bohn B, Riedel-Heller S, Karch A, Mikolajczyk R, et al. Increase in mental disorders during the COVID-19 pandemic—the role of occupational and financial strains. Dtsch Arztebl International. 2022;119(11):179–87.
35.
Satoh M, Murakami T, Obara T, Metoki H. Time-series analysis of blood pressure changes after the guideline update in 2019 and the coronavirus disease pandemic in 2020 using Japanese longitudinal data. Hypertens Res. 2022;45(9):1408–17.PubMedPubMedCentralCrossRef
36.
Beger C, Mayerböck A, Klein K, Karg T, Schmidt-Ott KM, Randerath O, Limbourg FP. Current practice of blood pressure measurement in Germany: a nationwide questionnaire-based survey in medical practices. Blood Press. 2023;32(1):2165901.PubMedCrossRef
37.
Niiranen TJ, Mäki J, Puukka P, Karanko H, Jula AM. Office, home, and ambulatory blood pressures as predictors of cardiovascular risk. Hypertension. 2014;64(2):281–6.PubMedCrossRef
38.
Omboni S, Panzeri E, Campolo L. E-Health in Hypertension management: an insight into the current and future role of blood pressure telemonitoring. Curr Hypertens Rep. 2020;22(6):42.PubMedCrossRef
39.
Beger C, Unger T, Haller H, Limbourg FP. Antihypertensive prescription patterns and cardiovascular risk in patients with newly diagnosed hypertension- an analysis of statutory health insurance data in Germany. Blood Press. 2020;29(6):357–61.PubMedCrossRef
40.
Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154(8):541–8.PubMedCrossRef
41.
Germano G, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Reimer W, Vrints C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012;33:1635–701.PubMedCrossRef
42.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseasesimplications for pay for performance. JAMA. 2005;294(6):716–24.PubMedCrossRef
43.
Mao Y, Ge S, Qi S, Tian Q-B. Benefits and risks of antihypertensive medication in adults with different systolic blood pressure: A meta-analysis from the perspective of the number needed to treat. Front Cardiovasc Med. 2022;9: 986502.PubMedPubMedCentralCrossRef
44.
Jurić D, Pavličević I, Marušić A, Malički M, Buljan I, Šarotić V, Mrduljaš-Đujić N, Komparak A, Vujević M, De Micheli-Vitturi D, et al. Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia. BMC Fam Pract. 2019;20(1):10.PubMedPubMedCentralCrossRef
45.
Tu K, Davis D. Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension. J Contin Educ Health Prof. 2002;22(1):11–22.PubMedCrossRef
46.
Swedlund M, Norton D, Birstler J, Chen G, Cruz L, Hanrahan L. Effectiveness of a best practice alerts at improving hypertension control. Am J Hypertens. 2019;32(1):70–6.PubMedCrossRef
47.
Adusumalli S, Kanter GP, Small DS, Asch DA, Volpp KG, Park S-H, Gitelman Y, Do D, Leri D, Rhodes C, et al. Effect of nudges to clinicians, patients, or both to increase statin prescribing: a cluster randomized clinical trial. JAMA Cardiol. 2023;8(1):23–30.PubMedCrossRef
48.
Neuhauser HK, Adler C, Rosario AS, Diederichs C, Ellert U. Hypertension prevalence, awareness, treatment and control in Germany 1998 and 2008–11. J Hum Hypertens. 2015;29(4):247–53.PubMedCrossRef
49.
McFarlane E, Olmsted MG, Murphy J, Hill CA. Nonresponse bias in a mail survey of physicians. Eval Health Prof. 2007;30(2):170–85.PubMedCrossRef
50.
Powell AE, Davies HTO, Thomson RG. Using routine comparative data to assess the quality of health care: understanding and avoiding common pitfalls. BMJ Qual Saf. 2003;12(2):122–8.CrossRef
51.
Jaunzeme J, Eberhard S, Geyer S. Wie „repräsentativ“ sind GKV-Daten? Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2013;56(3):447–54.PubMedCrossRef
52.
53.
54.
55.
McCarthy C, Murphy S, Cohen JA, Rehman S. Jones-O’Connor M, Olshan DS, Singh A, Vaduganathan M, Januzzi JL, Jr, Wasfy JH: Misclassification of Myocardial Injury as Myocardial Infarction: Implications for Assessing Outcomes in Value-Based Programs. JAMA Cardiol. 2019;4(5):460–4.PubMedPubMedCentralCrossRef
56.
Peng M, Chen G, Kaplan GG, Lix LM, Drummond N, Lucyk K, Garies S, Lowerison M, Weibe S, Quan H. Methods of defining hypertension in electronic medical records: validation against national survey data. J Public Health. 2016;38(3):e392–9.CrossRef
Metadata
Title
Quality of care in patients with hypertension: a retrospective cohort study of primary care routine data in Germany
Authors
Christoph Strumann
Nicola J. Engler
Wolfgang C. G. von Meissner
Paul-Georg Blickle
Jost Steinhäuser
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2024
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-024-02285-9

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