A national programme of hypertension control using a doctor-nurse team approach: the Israel experience.

Studies in Israel in the early 1970s showed that only about one-quarter of the men and half of the women with hypertension were on treatment and only about one-quarter of the treated males and half of the treated females were under control (diastolic blood pressure < 95 mmHg). Drop-out rate averaged about 30%. To improve detection and treatment of hypertension the nurses in the family clinics of Kupat Holim were taught to work with the family physicians in a team approach. This included a more efficient appointment system, case-finding, an active follow-up system for drop-outs, better documentation of findings and active health education. Reports are sent annually to a central registry in Tel Aviv. Results are tabulated and returned to the teams. Up to December 1983, 729 family practices (35.7% of the total number) were participating, and 46,909 patients are currently under treatment. This represents about half of the expected number of hypertensives in these practices. About three-quarters of the treated men and women are under control (diastolic blood pressure < 95 mmHg). Drop-out rate has fallen to 2.1% and waiting time from 105 to 7 min.