"Using a Multidisciplinary Team and Clinical Redesign to Improve Blood Pressure Control in Patients with Diabetes."

Abstract

OBJECTIVE: Optimal blood pressure (BP) control in patients with diabetes poses a challenge in primary care clinics because of the complexity of the disease and competing patient care demands. We used a multidisciplinary team to standardize and improve hypertension care for patients with diabetes by implementing a visual and action-oriented high BP prompt, collaborative practice agreement, medication intensification protocol, and home BP monitoring machine loan program. DESIGN: Prospective, pre-/poststudy. SETTING: General medicine clinic affiliated with a large academic healthcare system. PATIENTS: Two hundred sixty-three patients with type 2 diabetes mellitus. RESULTS: Hypertension control (ie, BP < 135/80 mm Hg) in patients with diabetes improved from 53.6% to 69.3% (P < .001) after implementing a standardized BP assessment and treatment process. There was also a significant decrease of 4 mm Hg in both the mean systolic and diastolic BPs after the intervention. The improvement in BP control was associated with an increase in the average number of antihypertensive medications from 1.56 to 1.93. CONCLUSIONS: The use of a process-oriented clinical redesign and a multidisciplinary team approach resulted in improved BP management in patients with diabetes in a primary care setting. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.