Yu, Esther Y. T.;
Wan, Eric Y. F.;
Mak, Ivy L.;
Chao, David V. K.;
Ko, Welchie W. K.;
Leung, Maria;
Li, Yim Chu;
Liang, Jun;
Luk, Wan;
Wong, Michelle M. Y.;
Ha, Tony K. H.;
Chan, Anca K. C.;
Fong, Daniel Y. T.;
Lam, Cindy L. K.
Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention
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Medientyp:
E-Artikel
Titel:
Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention
Beteiligte:
Yu, Esther Y. T.;
Wan, Eric Y. F.;
Mak, Ivy L.;
Chao, David V. K.;
Ko, Welchie W. K.;
Leung, Maria;
Li, Yim Chu;
Liang, Jun;
Luk, Wan;
Wong, Michelle M. Y.;
Ha, Tony K. H.;
Chan, Anca K. C.;
Fong, Daniel Y. T.;
Lam, Cindy L. K.
Erschienen:
American Medical Association (AMA), 2023
Erschienen in:
JAMA Network Open, 6 (2023) 5, Seite e2315064
Beschreibung:
<jats:sec id="ab-zoi230463-4"><jats:title>Importance</jats:title><jats:p>There is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term.</jats:p></jats:sec><jats:sec id="ab-zoi230463-5"><jats:title>Objective</jats:title><jats:p>To compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care.</jats:p></jats:sec><jats:sec id="ab-zoi230463-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>In this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212 707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023.</jats:p></jats:sec><jats:sec id="ab-zoi230463-7"><jats:title>Interventions</jats:title><jats:p>Nurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care.</jats:p></jats:sec><jats:sec id="ab-zoi230463-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Hypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic).</jats:p></jats:sec><jats:sec id="ab-zoi230463-9"><jats:title>Results</jats:title><jats:p>A total of 108 045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62 277 [57.6%] female) and 104 662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60 497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients.</jats:p></jats:sec><jats:sec id="ab-zoi230463-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this prospective matched cohort study involving 212 707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.</jats:p></jats:sec>