Implementation of local guidelines for cost-effective management of hypertension - A trial of the firm system
Implementation of local guidelines for cost-effective management of hypertension - A trial of the firm system
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DOI：
10.1007/bf02600265
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发表时间：
1996-03-01
影响因子：
5.7
通讯作者：
Aron, DC
中科院分区：
文献类型：
--
作者：
Aucott, JN;Pelecanos, E;Aron, DC
目的：评价实施高血压成本效益管理指南的强化干预对药物使用和成本、血压控制和其他资源使用的影响。设计：基于克利夫兰退伍军人事务医疗中心公司系统的回顾性队列试验。单位：一所大型大学附属退伍军人事务部医学中心的普通内科教学诊所。参与者：在指南引入后的3个月内，在干预公司（n = 1273）和对照公司（n = 884）诊所就诊的所有患者。干预措施：对照公司接受了高血压门诊成本效益管理的指南和常规教育。干预公司接受指导方针加上强化的指导教育和监督。测量和主要结果：与对照组相比，干预组对指南药物的使用更多。干预组有17.4%（95%可信区间[CI] 14.8, 20.1）的患者开始使用氢氯噻嗪（HCTZ），而对照组有11.9% (CI 9.3, 14.8) （p = 0.002）。阿替洛尔在干预组的起始率为7.2% (CI 5.6, 9.0)，对照组为4.7% (CI 3.2, 6.6) （p = 0.03）。此外，在干预公司中，非指南药物的使用较少。干预组的长效硝苯地平较少，为7.8% (CI 6.0, 9.8)，对照组为10.6% (CI 8.2, 13.5) （p = 0.04）。血压控制在干预组表现出更大的改善（p = 0.02）。与对照公司相比，干预公司总体上使用指南与降压药物成本降低有关。干预公司的其他测量资源的使用没有增加，包括获得的门诊实验室服务数量、诊所访问量、急诊室访问量或住院次数。结论：强化实施基于指南的教育和监督与指南药物的使用增加、昂贵替代药物的使用减少有关，并且护理的测量结果没有下降。
OBJECTIVE: To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use.DESIGN: Retrospective cohort trial based on the Cleveland Veterans' Affairs Medical Center Firm System.SETTING: General internal medicine teaching clinic in a large university-affiliate Department of Veterans Affairs Medical Center.PARTICIPANTS: All patients seen in the intervention firm (n = 1273) and control firm [n = 884] clinics in the 3-month period following the introduction of the guidelines.INTERVENTIONS: The control firm received guidelines and usual education for the cost-effective outpatient management of hypertension. The intervention firm received guide-lines plus intensive guideline-based education and supervision.MEASUREMENTS AND MAIN RESULTS: The use of guideline medications was greater in the intervention firm as compared with the control. The intervention firm initiated more hydrochlorothiazide (HCTZ), 17.4% (95% confidence interval [CI] 14.8, 20.1) of patients versus 11.9% (CI 9.3, 14.8) in the control firm (p = .002). Atenolol was initiated in 7.2% (CI 5.6, 9.0) in intervention firm versus 4.7% (CI 3.2, 6.6) in the control (p = .03). In addition, the use of nonguideline medications was less in the intervention firm. The intervention firm Initiated less long-acting nifedipine, 7.8% (CI 6.0, 9.8) versus 10.6% (CI 8.2, 13.5) in the control (p = .04). Blood pressure control demonstrated greater improvement in the intervention firm (p = .02). Use of guidelines was associated with decreased costs for antihypertensive medications in the intervention firm as a whole as compared with the control firm. There was no increased use In other measured resources in the intervention firm including the number of outpatient laboratory services obtained, clinic visits, emergency room visits, or hospitalizations.CONCLUSIONS: Intensive implementation of guideline-based education and supervision was associated with an increased use of guideline medications, decreased use of costly alternative agents, and no decrement in the measured outcomes of care.