Introduction and objectives: To evaluate the effect of a quality improvement intervention on the reduction of cardiovascular risk in patients with hypertension.
Patients and method: Quasi-experimental study involving two primary care centres. One centre was assigned to implement a quality improvement intervention (n = 482 patients), while at the other center "usual care" procedures were followed (control group, n = 360 patients). The quality improvement intervention consisted of a combined program designed for the medical staff and comprising audit, feedback, training sessions and implementation of clinical practice guidelines during 6 months. The main outcome measures were blood pressure, lipid levels, diabetes, smoking and cardiovascular risk. These values were compared before the intervention and after one year.
Results: The baseline characteristics of the patients were similar in both groups. Absolute cardiovascular risk decreased from 15.85% to 14.36% (P< .05) in the intervention group, and no significant change was observed in the control group (15.17% to 15.76%). The intervention led to a 2.07% decrease in cardiovascular risk (95%CI, 1.21-2.93; P< .05). The percentage of patients with high cardiovascular risk (> 20% at 10 years) decreased in the intervention group from 30% to 25%, and increased in the control group from 28% to 30%. Relative cardiovascular risk decreased from 2.03 to 1.75 (P< .05) in the intervention group, and from 1.98 to 1.92 (P> .05) in the control group. The intervention thus led to a 0.25 decrease in relative risk (95%CI: 0.14-0.35).
Conclusions: Absolute and relative cardiovascular risk in patients with hypertension was reduced by a quality improvement intervention. The percentage of patients with high cardiovascular risk was also reduced.