Improving hypertension detection and referral in an ambulatory setting.

A paraprofessional aide working in an urban hospital's ambulatory clinics encouraged nurses to take and record blood pressures; he then contacted patients with elevated pressures who were not referred by clinic staff or who did not return for follow-up of their own accord. Blood pressure recording by clinic staff increased during the intervention from 54% to 68% of patients seen. Appointment keeping increased with intervention from 13% to 73% of those eligible for referral. The yield of hypertensive patients initiating management increased from a control level of 7% to 22% of total patients eligible for referral. Thus, a health aide can be effective in improving detection and referral of hypertensive patients at low cost.