Improving the Detection and Management of Hypertension in Adults in the Primary Care Setting: A Quality Improvement Project Based on the Chronic Care Model using Blood Pressure Monitoring and Clinical Practice Guidelines
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Doctor of Nursing Practice
Family Nurse Practioner
Year Degree Awarded
Month Degree Awarded
ambulatory blood pressure monitoring, chronic care model, clinical inertia, hypertension, practice guideline, primary care
DNP Project Chair
Jean E DeMartinis
DNP Project Member Name
Background: Hypertension (HTN) is a common, costly, and deadly disease that is often under recognized, under diagnosed, and undertreated in the primary care setting. Despite the presence of effective treatment strategies, uncontrolled HTN remains a persistent problem.
Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to improve the quality of HTN care delivered to adults in a primary care practice. Goals were targeted to decrease providers’ clinical inertia by improving their ability to make better diagnosis and treatment decisions after reviewing more comprehensive objective data.
Methods: Using the Chronic Care Model in an independent primary care setting in New Hampshire an ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM), clinical practice guidelines, and patient and provider education were used to improve the detection and management of hypertension. Patients were followed over two to three visits including an initial visit for ABPM set-up and up to two subsequent HTN follow-up visits.
Results/Interpretations: One hundred percent of patients who underwent successful ABPM had their HTN status assessed and those with uncontrolled HTN had changes made to their medications to improve control. The percentage of patients with uncontrolled HTN decreased by more than half at visit two (44.7%) compared with visit three (20%), which was statistically significantly different, t (58) = 2.25, p = 0.028, 95% CI [0.027, 0.466].
Implications: QI projects addressing provider, system, and patient barriers may be effective at overcoming the barrier of providers’ clinical inertia and improving some patients’ self-management of their disease resulting in improved HTN control.
Keywords: ambulatory blood pressure monitoring, chronic care model, clinical inertia, home blood pressure monitoring, hypertension, practice guideline, primary care, self-efficacy