Aubin M, Vézina L, Maziade J, Robitaille N M
Unité de médecine familiale, Hôpital Laval.
Can Fam Physician. 1994 Oct;40:1742-52.
To evaluate the effectiveness of a program to improve hypertension control practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Three hospital-based family medicine centres (FMCs) PARTICIPANTS: Two study groups of 100 randomly-selected adult patients each, who visited the study FMC before implementation of the hypertension program (from April 1, 1983 to March 31, 1984) or afterward (from April 1, 1986 to March 31, 1987). These patients were compared to patients from control FMCs A and B seen during the same time frames (100 patients before and after at FMC A and 60 at FMC B). INTERVENTIONS: 1) Educational sessions for physicians to standardize knowledge of the recommendations of the Canadian Hypertension Society on hypertension treatment and 2) specific operational incentives to improve hypertension control, including a reference guide placed in each physician's office, a specific hypertension follow-up form placed with each patient's chart, a recall card file, and hypertension information handouts. MAIN OUTCOME MEASURE: Blood pressure measurements recorded in patient charts. Hypertension control is determined from the Canadian Hypertension Society recommendations. RESULTS: The hypertension control rate was 52% in the study group before program implementation and 34.3% afterward (p = 0.01); the corresponding rates in the two control groups moved from 47.4% to 59.8% (p > 0.05) in Group A and from 40.7% to 39.3% (p > 0.05) in Group B. Patients listed in the recall card file were not controlled more frequently (33.3%) than those not listed (35.3%). CONCLUSION: This intervention did not improve physician practice regarding hypertension control. Clinicians did not follow the protocol as recommended. Physicians must be convinced that a change in their practice is needed before any specific strategies are introduced to support the change. Different suggestions and alternatives related to hypertension management are discussed.
评估一项旨在改善基层医疗中高血压控制措施的项目的有效性。
回顾性准实验研究。
三个医院附属的家庭医学中心（FMCs）
两个研究组，每组100名随机选取的成年患者，他们在高血压项目实施前（1983年4月1日至1984年3月31日）或之后（1986年4月1日至1987年3月31日）就诊于研究性FMC。将这些患者与同期在对照FMC A和B就诊的患者进行比较（FMC A前后各100名患者，FMC B有60名患者）。
1）为医生举办教育课程，以规范加拿大高血压协会关于高血压治疗建议的知识；2）采取特定的操作激励措施以改善高血压控制，包括在每位医生办公室放置一份参考指南，在每位患者病历中放置一份特定的高血压随访表格，一个召回卡档案，以及高血压信息手册。
患者病历中记录的血压测量值。根据加拿大高血压协会的建议确定高血压控制情况。
项目实施前研究组的高血压控制率为52%，实施后为34.3%（p = 0.01）；两个对照组的相应比率在A组从47.4%变为59.8%（p > 0.05），在B组从40.7%变为39.3%（p > 0.05）。列入召回卡档案的患者的血压控制情况（33.3%）并不比未列入的患者（35.3%）更好。
这项干预措施并未改善医生在高血压控制方面的做法。临床医生未按照推荐方案执行。在引入任何支持改变的具体策略之前，必须让医生相信他们的做法需要改变。文中讨论了与高血压管理相关的不同建议和替代方案。
