Abstract Details

Title Out with the Old and In with the New - Understanding Barriers and Facilitators in Obtaining "New" Blood Pressure Goal for Patients with Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-001

Objective

To conduct a mixed methods study to understand provider perceptions of this guideline and assess whether Veterans Health Administration medical centers (VAMCs) routinely achieve this degree of post-stroke BP control.

Background

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) updated hypertension guidelines recommends a “new” goal blood pressure (BP) of <130/80 mmHg for stroke patients. Little is known regarding the barriers and facilitators perceived by healthcare providers to implementing this recommendation within routine clinical post-stroke care.

Design/Methods Chart review was conducted to determine the numbers of patients with hypertension who obtained ACC/AHA (i.e., <140/90 mmHg) and Joint National Committee (JNC)-8 recommended blood pressure (BP) goals (i.e., 130/80 mmHg). Thematic analysis was performed on 27 semi-structured qualitative interviews with providers, hospital and clinic administrators, and quality improvement staff conducted February-April 2018 at two diverse VAMCs. Interviews were conducted prior to the start of a CAre Transition and Hypertension (CATcH) improvement intervention. Code descriptions of “opinions regarding ‘new’ BP guidelines,” “barriers to BP management,” and, “facilitators to BP management” were compared across sites and among providers. A multidisciplinary team conducted consensus-based coding of transcripts.

Results

In the sixteen-months prior to the implementation of CATcH, facility-level pass rates for BP control were: 50% (18/36) patients at Site 1 and 64% (16/25) at Site 2 had obtained old goal BP, whereas 28% (10/36) at Site 1 and 20% (5/20) at Site 2 obtained new goal BP. Barriers and facilitators of bp management were identified at the patient-, provider-, and facility-levels (Table). Similar themes were seen across sites.

Conclusions Pre-intervention pass rates for BP need to improve. Multiple barriers and facilitators at the patient-, provider-, and systems-levels have been considered in designing the CATcH intervention, which seeks to incorporate the 2017 ACC/AHA hypertension guidelines into routine clinical care and improve on current facility-level performance.

Authors/Disclosures
Jason J. Sico, MD, FAAN PRESENTER	Dr. Sico has nothing to disclose.
	No disclosure on file
Sharon Bottomley, NP (Veterans Affairs Medical Center)	No disclosure on file
Lisa Keefner	No disclosure on file
	No disclosure on file
Paul W. Hurd, MD	No disclosure on file
	No disclosure on file

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