Changes in blood pressure in patients with hypertension in the context of delegated GP-home visits: A prospective implementation study

摘要

BACKGROUND: The AGnES-concept (GP-supporting, community-based, e-health-assisted, systemic intervention) includes the delegation of general practitioner (GP)-home visits to qualified practice assistants, especially in underserved areas. Most visited patients were elderly, multimorbid patients with limited mobility. We analyzed a subgroup of hypertension patients to assess the proportion of patients with controlled hypertension, the number of patients that changed between different categories of blood pressure during the project, and to identify possible determinants for these changes. MATERIALS AND METHODS: Eligible patients were selected by the participating GPs. Hypertensive patients with at least two blood pressure measurements were included. Two-level mixed-effects multiple binary logistic regression analyses were conducted to evaluate possible determinants for the found effects. RESULTS: Overall, 776 patients (mean age 79.2 years; SD 8.1 years; range 38-98 years) were included in the analysis. During the project, the mean values for systolic (from 136.1 to 131.0 mmHg, P<0.0001) and diastolic (from 77.0 to 75.7 mmHg, P=0.0026) blood pressure decreased. In 26.0% of the patients there was a change from hypertensive blood pressure values to normotensive values and vice versa in 14.3% (P<0.0001). Multilevel regression models did not show single elements of the complex intervention as determinants for changing to normotensive blood pressure values. CONCLUSION: Although the study was conducted under real life conditions and therefore had some methodological limitations, the delegation of home visits to qualified practice assistants may have had a positive influence on changes of blood pressure with elderly hypertension patients. The study population represents a relevant population for medical care, which might benefit from the implementation of the AGnES-concept. ? 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.