Abstract
Background: The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice. Methods. We conducted a practice- based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient's medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM). Results: Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure. Conclusions: When primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented strategies to improve adherence.
| Original language | English |
|---|---|
| Article number | 86 |
| Journal | BMC Family Practice |
| Volume | 12 |
| DOIs | |
| Publication status | Published - 2011 |
Bibliographical note
Funding Information:The authors wish to thank Dr. Paul Veugelers for his advice regarding hierarchical non-linear modeling, and Ms. Charmaine Cooke for her assistance with drug analysis. Dr. Preston Smith and Dr. Michael Murray contributed to the development of our project and to the recruitment of patients from their private practices. We also wish to thank all of the participating family physicians and nurse practitioners who recruited patients for this study, and the patients themselves for their willingness to be involved and to complete our mail survey. The operating funding for this phase of our project was provided by the Canadian Institutes of Health Research ROP-82512, the Nova Scotia Health Research Foundation, and the Heart & Stroke Foundation of Nova Scotia. The BpTRU™ equipment used in this study was funded by the Office of Research Services of the Faculty of Medicine Dalhousie University, and the Capital District Health Authority of Halifax, Nova Scotia. The earlier phase of our study, which was essential to the main report, was also supported by the Dalhousie Medical Research Foundation, and the Prince Edward Island Health Research Institute. Ingrid Sketris holds a Canadian Health Services Research Foundation/ Canadian Institutes of Health Research Chair in Health Services Research, cosponsored by the Nova Scotia Health Research Foundation.
ASJC Scopus Subject Areas
- Family Practice
