Strategies for improving the physician's compliance during medical care of patients with arterial hypertension

The aim of the present study was to investigate prospectively the value of different forms of intervention in the quality of diagnosis and treatment of essential hypertension in an outpatient clinic. In a first phase (phase O) 115 patients with a blood pressure of ≥140/≥90 mmHg at the initial visit in our outpatient clinic were registered. After a 3-month period the charts of these patients were reviewed. This review revealed that 61 (53%) of these patients were not followed by the treating physicians and that half the patients who had elevated blood pressure at the second visit and thereby an indication for therapy, were not treated. In a first intervention the results of this investigation were discussed with the treating physicians and the necessity for an improved management of patients with essential hypertension was pointed out. After this intervention 116 patients with blood pressure ≥140/≥90 mmHg were again followed for 3 months without knowledge of the treating physicians (phase 1). The chart review of these patients revealed no improvement in the management of the patients, 57% of these patients were again not followed by the treating physicians and 48% of the patients identified by a follow-up visit as hypertensives were not treated. Thereafter, a second intervention took place which included a nurse who scheduled 1533 patients with an initial blood pressure of ≥140/≥90 mmHg automatically for a follow-up visit, the charts of patients with the above blood pressures were labelled with a visible marker (phase 2). With these measures 130 (8%) of the patients were not correctly followed and only one of 94 patients with confirmed hypertension was lost for initiation of treatment. Whereas verbal information alone failed to improve the management of patients with essential hypertension in our physicians, simple administrative measures improved the compliance of the physicians in the diagnosis and initiation of therapy of hypertension.