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EFFECTIVENESS OF A MEDICAL EDUCATION INTERVENTION TO TREAT HYPERTENSION IN PRIMARY CARE

EFFECTIVENESS OF A MEDICAL EDUCATION INTERVENTION TO TREAT HYPERTENSION IN PRIMARY CARE.

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EFFECTIVENESS OF A MEDICAL EDUCATION INTERVENTION TO TREAT HYPERTENSION IN PRIMARY CARE

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  1. EFFECTIVENESS OF A MEDICAL EDUCATION INTERVENTION TO TREAT HYPERTENSION IN PRIMARY CARE Authors: Silvia Martínez-Valverde MSc1, Hortensia Reyes-Morales MD, MSc, DrSc.2,Angélica Castro-Ríos MHE. 3, Ricardo Pérez-Cuevas MD, MSc, DrSc.3, Miguel Klunder-Klunder MSc.1, Guillermo Salinas-Escudero MSc.1. Institutions: 1Center for Social and Economic Studies on Health. Hospital Infantil de México Federico Gómez 2Center forHealthSystemsResearch, NationalInstitute of PublicHealth 3Epidemiology and HealthServicesResearchUnit, Instituto Mexicano del Seguro SocialMexico NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  2. Introduction In México, hypertension is among the top five causes of visit to primary care clinics, and its complications are among the main causes of emergency services and hospital care. The interventions to tackle this growing problem comprise public health programs that include prevention and health promotion activities and screening. Public healthcare systems have developed evidence-based clinical guidelines in accordance with international recommendations, but suitable for local use during their daily practice. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  3. Introduction The guidelines have been used as a tool in continuing medical education programs, and it is expected that practitioners would use them. Continuing medical education (CME) consists of educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a medical doctor uses to provide services to the patients. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  4. Objective To evaluate the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  5. Methods Design:A secondary data analysis was carried out using data of hypertensive patients treated by family physicians who participated in the Continuing Medical Education intervention. Setting: The study was conducted at a national level in six family medical clinics belonging to the Mexican Institute of Social Security (IMSS), the largest public health care system in Mexico. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  6. Methods Study Population: The analysis included 193 patients with hypertension (intervention group: n = 101 patients; control group: n = 92 patients), who were treated by 90 physicians. Intervention: The intervention was based on three sequential stages that lasted 3 months. In each setting, a general internal medicine specialist was trained to coordinate the interventions and to work as a clinical instructor. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  7. Methods An evidence-based clinical guideline was previously designed and adapted to the family medicine context and served as the groundwork for the intervention. Analysis: The effect of the CME intervention was analyzed using multiple logistic regression modeling in which the dependent variable was uncontrolled blood pressure in the post-intervention patient measurement. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  8. Methods The operational definition of uncontrolled blood pressure states that the systolic/diastolic figures should be ≥140/90 mmHg5. Outcome measure : Proportion of patients with uncontrolled blood pressure in the intervention and control groups at baseline and final stages. NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  9. Results: Baseline characteristics * p <0.05 Hospital Infantil de México Federico Gómez NationalInstitute of PublicHealth, Mexico

  10. Results: Baseline Clinical Data

  11. Results:Patients with uncontrolled blood pressure in both groups at baseline and final evaluation stages . pp: percentage points p: p value between groups Hospital Infantil de México Federico Gómez NationalInstitute of PublicHealth, Mexico

  12. Multiple Logistic Regression Model: CME intervention with uncontrolled blood pressure Hosmer-Lemeshow goodness of fit, Prob > 2 = 0.5683 NationalInstitute of PublicHealth, Mexico Hospital Infantil de México Federico Gómez

  13. The analysis demonstrated that a multifaceted intervention of CME increase the probability to control blood pressure in hypertensive patients. • The results highlight the importance of providing dietary recommendations. Dietary recommendations are a proxy that can be used to ascertain whether patients change their dietary habits to control their body weight and decrease their blood pressure. Conclusions Hospital Infantil de México Federico Gómez NationalInstitute of PublicHealth, Mexico

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