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Am Fam Physician. 2005;71(10):2008-2010

The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services has published a technical review on improving the quality of care for patients with hypertension. “Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Volume 3 – Hypertension Care” (AHRQ Publication no. 04–0051–3) was released in January 2005 and is available online at

The authors searched MEDLINE, the Cochrane Effective Practice and Organisation of Care Review Group registry, and other databases, and hand searched bibliographies and articles for experimental evaluation of quality-improvement interventions in the care of non-pregnant patients with primary hypertension.

Quality improvement targets included measures of blood pressure screening (i.e., strategies to increase the awareness of hypertension in undiagnosed patients) and control (i.e., the percentage of diagnosed patients whose blood pressure is within the range recommended by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure [less than 120/80 mm Hg]). Sixty-three articles met the inclusion criteria. The strategies assessed in the studies were organizational change, education of patients and health care professionals, facilitated relay of clinical data, audit and feedback, promotion of self-management, reminders for physicians and patients, and financial incentives.

The authors’ findings suggest that quality improvement strategies are associated with improved detection and control of hypertension, but they could not discern which strategies have the greatest effect. Studies that involved organizational change appeared to have the largest positive effect; however, there were some methodologic concerns about confounding because of study size, and the authors note that organizational change may be only an indication of high levels of administrative support or funding. Patient education also appeared to have a large positive effect, but the results were confounded by study size. Studies that focused on improving physician adherence to recommendations for hypertension management had less effect. The authors noted that there may be several reasons for this, including rapidly changing recommendations and time and resource constraints.

The authors concluded that the most noticeable finding was the need for more high-quality research to clarify the best strategies with which to improve the care of patients with hypertension.

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