In order to make meaningful gains in cardiovascular disease care, primary care medical practices should adopt a set of care improvements specific to their practice size and type, according to a new study from the national primary care quality improvement initiative EvidenceNOW. High blood pressure and smoking are among the biggest risk factors associated with cardiovascular disease. Primary care physicians help patients manage high blood pressure and provide smoking cessation interventions.
Researchers found that there is no one central playbook for all types of practices, but they did identify combinations of practice characteristics, amount of practice facilitation, and operational changes linked with improved cardiovascular disease care. Smaller, solo and clinician-owned practices that changed routine aspects of their process, such as training medical assistants to perform accurate blood pressure readings; allowing staff to take repeated blood pressure measures and note second readings in electronic medical records; and equipping clinicians with the tools to perform smoking screening and cessation referrals, were able to make substantial improvements.
In addition, working with a practice facilitator helped. Smaller practices that participated in a moderate amount of facilitation were able to make these improvements. However, for larger hospital or health system-owned practices and Federally Qualified Health Centers more facilitation was necessary, leading researchers to conclude that "making operational changes alone--in certain clinical settings--was insufficient to achieve meaningful improvements." In practices that are part of larger, more complex systems, external facilitation along with prioritization of operational changes may be critical to successful quality improvement.
Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
Deborah J. Cohen, Ph.D., et al
Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
In a corresponding editorial titled "The Need for Coaches in a Clinical World", Robert L. Phillips, Jr, MD, MSPH, of the American Board of Family Medicine, identifies a common thread running throughout five studies in the May-June 2021 issue Annals of Family Medicine. Dr. Phillips notes that practice facilitation is key to improving primary care at a systems level. Each study he discusses investigates a different, though widely experienced, medical issue, including cardiovascular disease, antibiotic resistance, chronic pain and addiction and cesarean births. He writes that these studies offer meaningful insights about facilitating behavior change, the importance of culture, and respecting complexity.
The Need for Coaches in the Clinical World
Robert L. Phillips, Jr, M.D., MSPH
American Board of Family Medicine, Lexington, Kentucky