Hypertension case management in Yerevan ambulatory settings

Abstract

Hypertension is one of the major contributors to atherosclerotic cardiovascular disease, the leading cause of death in Armenia. Hypertension case management patterns have significantly changed over the last decades. An early detection and lifelong hypotensive therapy have been proved to be critical in the prevention of hypertension related adverse outcomes, such as cardiac failure, stroke, coronary heart disease, and peripheral artery disease. This study is a pilot study attempting to assess relationships between the quality of hypertension case management by primary health care providers in Yerevan, Armenia and hypertension-related adverse outcomes. Study design: case-control unmatched study. Setting: community-based primary health center (district policlinic) in Yerevan, Armenia. Data source: records in ambulatory medical charts of stroke and non-stroke hypertensive patients. Sampling: all available cases and controls in the policlinic purposively selected of 28 located in Yerevan. Population: cases were defined as ambulatory patients with first-ever stroke developed in the period of time from January to July of 1997 who had previously diagnosed hypertension. Controls were defined as ambulatory hypertensive patients without stroke who applied for physician home visit because of hypertension during the same period of time. Cases and controls were identified through multiple administrative data sources. Analysis: the assessment of management of hypertensive patients prior to stroke (for controls-prior to a home visit) was done on the base of scored checklist. Criteria for the assessment of hypertension case management were established on the basis of literature review and the local protocols. All items were equally weighted in the checklist. Number of fulfilled criteria was characterized as hypertension case management (HCM) adherence scores. Depending on the adherence scores calculated for each of cases and controls, HCM was classified as "fair" or "poor". Results: no statistically significant differences were detected in the management of patients in the case and control groups except for the patients aged over 60 years. These results concur with the meta-analysis of randomized studies in which greater benefits of hypertensive treatment were detected in elderly patients