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clinmed/2002120002v1 (February 13, 2003)
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Narrowing the gap in Hypertension: Efficacy of a Complex Antihypertensive Intervention Program in the Elderly – (CAIPE).
Small reductions in systolic blood pressure are significantly associated with clinical benefits.1 In Argentina, as well as in other countries, studies performed in elderly population from different socioeconomic level, showed a low control of blood pressure .2-6
Even in financed health care, high blood pressure control does not achieve its goal7 8 suggesting that other factors may play an important role. Resistance to comply with treatment due to the asymptomatic nature of the disease and clinical inertia are some of these mentioned factors.9
Disease management programmes have been developed to narrow the clinical evidence and practice gap.10
In our setting, a university-associated teaching hospital, we designed a Complex Antihypertensive Intervention Program in the Elderly (CAIPE) being its primary objective to improve high blood pressure control in the population we serve.
To assess efficacy of the CAIPE, we conducted a quasi-experimental individual based programme trial.11 A group of patients included in such programme was compared to another group under usual care. Outcome measures were differences in systolic blood pressure level and in proportion of well-controlled patients between groups.
METHODS:
Study Sample
In our hospital, primary care of the elderly is organized in two health care modalities. Eighty per cent of these patients are followed-up by clinicians. All new elderly affiliates are allocated to this health care system. The remaining 20% of patients are followed by family physicians and were affiliated being younger. We allocated patients and physicians from the former group to receive the intervention and patients from the family practice care, whose physicians were not intervened, to be controls.
Recruitment
The first 2200 patients detected hypertensive in the screening stage of the CAIPE were eligible. 7 Two hundred and fifty patients were randomly selected from each medical group.