Department of Family Medicine, Greenville Health System, Greenville, SC, USA.
University of South Carolina School of Medicine-Greenville, Greenville, SC, USA.
J Clin Hypertens (Greenwich). 2018 Jan;20(1):79-87. doi: 10.1111/jch.13141. Epub 2018 Jan 5.
Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence-based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6-month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM-907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self-monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.
测量准确、快速行动并与患者合作(MAP)是一项基于证据的方案,旨在改善服务不足患者(49.9% Medicaid 和 50.2%黑人)的高血压控制。在干预前一年接受过高血压治疗且在 6 个月干预期间至少有一次就诊的患者(N=714)被纳入研究。如果初始就诊时血压(BP;标准无液气压计)≥140/≥90mmHg,则使用欧姆龙 HEM-907XL 重复测量三遍并平均(测量准确)未就诊的自动诊室 BP。当自动诊室 BP≥140/≥90mmHg 时,快速行动包括评估治疗惰性的降压药物强化。与患者合作包括血压自我监测、减少药物负担和尽量降低药物成本,这是通过每次治疗强化的收缩压变化来评估的。在基线和最后一次研究访视之间,血压控制到<140/<90mmHg 的比例从 61.2%增加到 89.9%(P<.0001)。MAP 迅速显著改善了医疗服务不足患者的高血压控制,这主要是由于准确测量血压和与患者合作。