Dataset Information

Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000.

ABSTRACT:

Objectives

In England, many hypertensives are not detected by primary medical care. Higher detection is associated with lower premature mortality. We aimed to summarise recent evidence on detection and interventions to improve detection in order to inform policies to improve care.

Design

Data sources: systematic review of articles published since 2000. Searches of Medline and Embase were undertaken. Eligibility criteria: published in English, any study design, the setting was general practice and studies included patients aged 18 or over.

Exclusion criteria

screening schemes, studies in primary care settings other than general practice, discussion or comment pieces.

Participants

adult patients of primary medical care services.

Synthesis

study heterogeneity precluded a statistical synthesis, and papers were described in summary tables.

Results

Seventeen quantitative and one qualitative studies were included. Detection rates varied by gender and ethnic group, but longitudinal studies indicated an improvement in detection over time. Patient socioeconomic factors did not influence detection, but living alone was associated with lower detection. Few health system factors were associated with detection, but in two studies higher numbers of general practitioners per 1000 population were associated with higher detection. Three studies investigated interventions to improve detection, but none showed evidence of effectiveness.

Limitations

The search was limited to studies published from 2000, in English. There were few studies of interventions to improve detection, and a meta-analysis was not possible.

Conclusions and implications

Levels of detection of hypertension by general practices may be improving, but large numbers of people with hypertension remain undetected. Improvement in detection is therefore required, but guidance for primary medical care is not provided by the few studies of interventions included in this review. Primary care teams should continue to use low-cost, practical approaches to detecting hypertension until evidence from new studies of interventions to improve detection is available.

SUBMITTER: Baker R

PROVIDER: S-EPMC5875641 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000.

Baker Richard R Wilson Andrew A Nockels Keith K Agarwal Shona S Modi Priya P Bankart John J

BMJ open 20180322 3

<h4>Objectives</h4>In England, many hypertensives are not detected by primary medical care. Higher detection is associated with lower premature mortality. We aimed to summarise recent evidence on detection and interventions to improve detection in order to inform policies to improve care.<h4>Design</h4>Data sources: systematic review of articles published since 2000. Searches of Medline and Embase were undertaken. Eligibility criteria: published in English, any study design, the setting was gene ...[more]

PMID: 29567850

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Project description:Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.

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Dataset Information

Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000.

Objectives

Design

Exclusion criteria

Participants

Synthesis

Results

Limitations

Conclusions and implications

Publications

Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000.

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