Improving detection of high blood pressure 

A targeted initiative to check more patients for high blood pressure (hypertension) was successful in identifying 545 cases which had previously been undiagnosed, enabling these patients to receive treatment and monitoring, to help prevent them from having a heart attack or a stroke.

The challenge:

More than 173,000 people registered at GP practices in LLR had already been diagnosed with hypertension, but we knew that there were likely to be many more who had not yet been diagnosed. According to our estimates, there could be almost 47,000 patients across LLR with undiagnosed hypertension and we were especially concerned to test patients who do not normally visit their GP practice, many of whom are working and would find it difficult to attend on weekdays. 

We were keen to go “further and faster” in this area because the sooner we can find and diagnose people with hypertension, the more likely it is that we will save them from having a large-scale CVD event such as a heart attack or a stroke, at a time when our system is already under enormous pressure, particularly in acute care.

The solution:

We set up a targeted initiative, focused on five Primary Care Networks (PCNs), which included the five GP practices in LLR which have the greatest gap in observed versus expected Hypertension prevalence.  In total 27 practices took part, across five PCNs: Leicester City South, Aegis, Hinckley Central, Oadby & Wigston and Carillon. 

Patients from the 27 practices were invited for a blood pressure check on a Saturday or a weekday evening (during Enhanced Access hours), either at their GP practice or local community pharmacy, having been identified using the following risk factors for hypertension:

  • 40 – 65 years old
  • BMI (body mass index) over 30
  • Smokers
  • Carers aged 40 – 65 years old
  • Blood pressure checks not undertaken in the last 3 years.

The practices were offered PDF files to import into the clinical reporting section and were able to identify the target cohort of patients to invite for a blood pressure check. Some practices employed additional staff for weekends to run these sessions. 

Impact:

Over a six-week period involving 27 GP practices, more than 4,000 patients were tested, 545 of which were diagnosed with hypertension, which means that they can now receive treatment and monitoring, to help prevent them from having a serious CVD (cardio-vascular disease) event such as a heart attack or a stroke.

Setting up the clinics outside of normal working hours was effective, as four out of five patients who were invited attended their appointment. By managing hypertensive patients with medication, dietary and lifestyle support, we can reduce the risk of serious illness including heart disease, stroke and kidney failure, as well as disability and premature death.

We are now working closely with community pharmacies to increase the number of patients tested who are at risk of having undiagnosed hypertension. We are also planning to use mobile units from January 2024, in order to provide blood pressure tests in specific neighbourhoods and communities. 

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