Provider Adherence to National Guidelines for Managing Hypertension in African Americans

Purpose. The purpose of this retrospective chart review is to evaluate health care provider adherence to national guidelines for the treatment of hypertension in African Americans. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines were used as the basis for comparison to documented care.
Design. This pilot exploratory study used a descriptive, pre-experimental, quantitative method to conduct a retrospective chart review for African American patients aged 20 to 80 years old who had been diagnosed with hypertension to examine the degree of provider adherence to national hypertension management guidelines.
Methods. The electronic medical records (EMR) in a rural clinic were reviewed from July 1, 2014 through August 31, 2014 to identify patients who were African Americans aged 20 to 80 years diagnosed with hypertension and were taking antihypertensive medications. Demographic data collected included age, gender, marital status and health insurance. Clinical data collected included blood pressure, medications prescribed, laboratory studies including urine micro-albumin levels (if diabetic), lifestyle modification recommendations, referral to specialized professionals and frequency of follow-up. Clinical data were compared to the JNC recommendations.
Findings. Overall provider adherence averaged 75%. Provider adherence was present on 87% of participants on combination therapy and 0% in patients on monotherapy. Weight loss, sodium restriction and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption was only documented in 6.5% of the participants. Provider follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of the patients. Only 15.2% of diabetics were ordered micro albumin levels. Laboratory adherence prior to beginning pharmacologic regimens was documented in 0% of the patients and biannual routine labs were documented prior to beginning treatment 65% of the time.
Conclusion. Provider adherence is moderately high in prescribing TDs or CCBs as combination therapy. Provider adherence is poor in prescribing TDs or CCBs in monotherapy. However, there appears to be no relationship to provider adherence and blood pressure outcomes. These findings may be due to the short time period of the study and documentation being available in the EMR for only the last five years. These findings warrant further research.