Hospital-based intervention to enhance hypertension diagnosis in Kalasin hospital, Thailand, 2017-2019: A pre-post pilot intervention study.

In Thailand 5.9 million individuals ≥15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre- and post-intervention hypertension diagnosis rate and follow-up rate. A hospital-based pre- and post-intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop-up alert when raised blood pressure was observed and a follow-up protocol. The follow-up protocol entered patient information in a follow-up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow-up between the pre- and post-intervention periods, adjusted for differences in baseline characteristics. A post-intervention, self-report survey among nurses and nurse-aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre-intervention period; 27.4% returned for follow--up; and hypertension diagnosis rate was 1.4%. Among 686 post-intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per-protocol patients, 81.9% were booked to follow--up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre-intervention period. By self-report, 20% of health workers had no time to provide the follow-up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow-up. The interventions significantly increased the hypertension diagnosis rate and follow-up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology-assisted follow-up protocol.