Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives
Abstract
The role of clinical inertia in the treatment of patients with hypertension was assessed by evaluating health care providers' knowledge, attitudes, and clinical practices regarding hypertension management. A cross-sectional survey was conducted at the Forsyth Medical Group in North Carolina. Participants were physicians (N = 18, 10 sites) and support staff (N = 20, 12 sites), who were surveyed in 2006. Physician and support staff questionnaires consisted of 29 and 15 items, respectively, and were administered by trained interviewers. Though most physicians (94%) cited familiarity with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines and affirmed that hypertension management guidelines are relevant to their patients, no physicians interviewed routinely document patient hypertension management plans. Although 1 in 3 physicians cited the inability to devote enough time to patients for the discussion of hypertension management, physicians predominantly cited patient- and support-staff- related factors as most important to patients not attaining blood pressure (BP) goal. Patient lifestyle modification (89%), education (67%), and medication compliance (56%) were cited as the most important reasons for uncontrolled BP. Only one-third of physicians believe that clinical staff always obtain accurate BP measurements, and 61% believe that resistant hypertension is a reflection of inaccurate BP measurement. Many support staff claimed to be rushed when measuring patient BP, and 65% recommended BP competency training. Contradictions were evident between provider knowledge of hypertension management standards and how this knowledge is applied in clinical practice. Standardized collection of BP is critical to measuring clinical improvement in hypertension. Results are being utilized to develop clinical improvement initiatives including staff education and competency training.
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A quarter of patients who are newly initiated on antihypertensive therapy fail to fill their initial prescription.
“However, a quarter of patients who are newly initiated on antihypertensive therapy fail to fill their initial prescription.97,98”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [97]
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- Authors
- Holland, N., Segraves, D., Nnadi, V. O., Belletti, D. A., Wogen, J., & Arcona, S.
- Affiliations
- Novant Health Forsyth Medical Center (US)
- Novartis (United States) (US)
- Tocalo Co., Ltd. (Japan) (JP)
- ORCID
- Arcona, Steve
- Venue
- Disease Management
- Publisher
- SAGE Publications
- Published
- 2008-04
- Volume
- 11
- Issue
- 2
- Pages
- 71-77
- ISSN
- 1093-507X (ISSN-L)
- 1557-8860
- OpenAlex
- W2060435337
- Cited by
- 54
- References
- 11
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 4 · 2018: 8 · 2017: 6 · 2016: 4 · 2014: 3 · 2013: 2 · 2012: 3
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disease Management (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novartis Pharmaceuticals Corporation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- antihypertensive therapy, clinical inertia, barriers to care, physician knowledge and attitudes, JNC 7 guidelines, blood pressure goal attainment, uncontrolled hypertension, medication adherence, lifestyle modification, blood pressure measurement accuracy, resistant hypertension, support staff, quality improvement
- MeSH terms
- Attitude of Health Personnel, Cross-Sectional Studies, Health Services Accessibility, Health Services Needs and Demand, Humans, Hypertension, Health Knowledge, Attitudes, Practice, North Carolina, Patient Compliance, Quality of Health Care, Surveys and Questionnaires, Health Care Surveys, Qualitative Research
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