Feasibility of a checklist in treating hypertension in primary care - base line results from a cluster-randomised controlled trial (check and support)

Aapo Tahkola, Päivi Korhonen, Hannu Kautiainen, Teemu Niiranen, Pekka Mäntyselkä, Aapo Tahkola, Päivi Korhonen, Hannu Kautiainen, Teemu Niiranen, Pekka Mäntyselkä

Abstract

Background: Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence.

Methods: The study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30-75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol.

Results: In total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention.

Conclusions: Even highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem.

Trial registration: NCT02377960 . Date of registration: February 26th, 2015.

Keywords: Checklist; Hypertension; IMB model; Initiation; Medication; Primary care; Target.

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from all the participants prior to the beginning of the study. The institutional review board of the Hospital District of Northern Savo has approved the study protocol (reference: 63/2014).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of the study. AUDIT-C: alcohol use disorders identification test; BMI: Body Mass Index; BP: Blood pressure; ECG: electrocardiogram; EQ-5D: EuroQoL questionnaire of health-related quality of life; FIT index: Frequency-Intensity-Time (FIT) Index, Laboratory tests: fasting plasma glucose level, fasting plasma cholesterol level, existence of proteinuria, creatinine level
Fig. 2
Fig. 2
Checklist for initiation of medication. After filling in the checklist with the clinician, the patients received a copy of it for themselves, together with enclosed written information. Underlined sections refer to written information enclosed with the checklist. This information included five alternative medication guides depending on the physician’s choice. IMB model relations: Items 1, 2 and 9 concerned behavioural skills; items 5, 6 (documents given to the patient) and 8 concerned Information; items 3 and 4 concerned motivation and item 7 was an agreement on launching SMS text message support
Fig. 3
Fig. 3
Outcomes in the context of the IMB model. Positive study outcomes in the context of the Information-Motivation-Behavioural skills model for medication adherence. Picture presents only the outcomes that differed significantly between the groups

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