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Hypertension management in primary health care : a survey in eight regions of Sweden

Hellgren, Mikko ; Wennberg, Patrik ; Hedin, Katarina LU ; Jansson, Stefan ; Nilsson, Staffan ; Nilsson, Gunnar ; Wändell, Per and Bengtsson Boström, Kristina (2023) In Scandinavian Journal of Primary Health Care 41(3). p.343-350
Abstract

Purpose: To explore hypertension management in primary healthcare (PHC). Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. Setting: Seventy-six PHCCs in eight regions of Sweden. Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of... (More)

Purpose: To explore hypertension management in primary healthcare (PHC). Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. Setting: Seventy-six PHCCs in eight regions of Sweden. Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300–11300) patients. Conclusions: The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, general practice, hypertension, lifestyle factors, primary health care
in
Scandinavian Journal of Primary Health Care
volume
41
issue
3
pages
8 pages
publisher
Taylor & Francis
external identifiers
  • pmid:37561134
  • scopus:85167700443
ISSN
0281-3432
DOI
10.1080/02813432.2023.2242711
language
English
LU publication?
yes
id
9fd255f1-7184-41a1-8568-b2f08d005b53
date added to LUP
2023-12-01 13:21:03
date last changed
2024-04-14 14:26:19
@article{9fd255f1-7184-41a1-8568-b2f08d005b53,
  abstract     = {{<p>Purpose: To explore hypertension management in primary healthcare (PHC). Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. Setting: Seventy-six PHCCs in eight regions of Sweden. Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p &lt; 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300–11300) patients. Conclusions: The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.</p>}},
  author       = {{Hellgren, Mikko and Wennberg, Patrik and Hedin, Katarina and Jansson, Stefan and Nilsson, Staffan and Nilsson, Gunnar and Wändell, Per and Bengtsson Boström, Kristina}},
  issn         = {{0281-3432}},
  keywords     = {{Blood pressure; general practice; hypertension; lifestyle factors; primary health care}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{343--350}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Hypertension management in primary health care : a survey in eight regions of Sweden}},
  url          = {{http://dx.doi.org/10.1080/02813432.2023.2242711}},
  doi          = {{10.1080/02813432.2023.2242711}},
  volume       = {{41}},
  year         = {{2023}},
}