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JCOM Abstract

J Clin Outcomes Manage 
2007 Jan;14(1):32-40
Provider adherence to JNC7 guidelines and blood pressure outcomes in African Americans
Peters RM, Benkert R, Butler K, Brunelle N

Abstract Objective: To measure provider adherence with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and assess whether adherence is associated with improved blood pressure (BP) control among low-income African-American patients. Design: Chart review. Setting and participants: A primary care clinic for low-income patients within an urban, university health center. Data were obtained from charts of 128 hypertensive African-American patients enrolled in a larger study. Measures: The Hypertension Quality Chart Review Index was used to measure adherence in the areas of cardiovascular risk assessment, lifestyle modification, pharmacologic treatment, and follow-up care. Patient BP was also recorded. Results: Overall provider adherence averaged 76%. Mean adherence scores were 85% for cardiovascular risk assessment, 57% for lifestyle intervention, 69% for pharmacologic treatment, and 80% for follow-up care. Adherence to follow-up care was significantly related to BP goal attainment (r = 0.23; p < 0.05). Mean BP values decreased but the changes were not significant. Nurse practitioners had higher total quality scores, while physicians achieved greater decreases in diastolic BP. There were no significant differences in BP goal attainment by provider type. Conclusion: Fairly high adherence with JNC 7 guide-lines was noted, but it was not related to BP goal attainment. Lower adherence scores may reflect problems with documentation rather than practice.

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