Hypertension control program of the Negev: Evaluation after two years of intervention

In 1981 a nationwide effort to control high blood pressure was implemented. One of the first programs was the "Hypertension Control Program of the Negev." The program's major objective was to introduce early detection and improve diagnostic, treatment, and follow-up procedures to 27 primary-care clinics of the area. The evaluation was based on the program's three levels of intervention: (a) basic training program and written protocol, containing guidelines for diagnosis, treatment, and follow-up; (b) additional consultation in the primary-care clinics by internal medicine specialists from the regional medical center, and (c) additional consultation in the primary-care clinics by the hypertension unit's medical team. In 1981 (prior to any intervention) a random sample of 5,717 medical records of the target population (30 years or older) was reviewed. High blood pressure was found in 1,032 patients (18%); however, a written diagnosis of hypertension was recorded in only 57% of these cases, and of these only 37% were being regularly treated for high blood pressure. In 1983, a second, independent random sample of 7,791 records was reviewed. High blood pressure was again found in 18% (1,428) of the cases, but 69% of these had a recorded high blood pressure diagnosis (a relative increase of 21% from 1981), and 85% of these were treated for high blood pressure (a relative increase of 130%). Improved performance in the steps of care provided for high blood pressure was observed in all the clinics. Surprisingly, the percentage of well-controlled patients increased only in those clinics where the staff gave consultation services. It is suggested that these different outcomes can be explained by the different levels of intervention.