Improving Hypertension Control In A Veterans Affairs Resident Primary Care Clinic, A Mixed-Methods Study

Introduction: Hypertension (HTN) is a critical modifiable risk factor for cardiovascular disease (CVD). In 2017, ACC/AHA guidelines recommended a blood pressure (BP) target of ≤ 130/80 mmHg for patients with high CVD risk. Prior research in the primary care clinic showed poor adherence with up-to-date guidance for BP control. The current study targets resident physician prescribing barriers to improve HTN control. Method: The study was conducted in a large Midwest VA Patient Aligned Care Team (PACT) staffed by 49 Internal Medicine resident physicians and 10 supervising physicians. Physician prescribing barriers were identified via semi-structured interviews. Interventions included physician education on BP goals and treatment, guided self-audit exercise, and revised implementation of EMR HTN order menu. Therapeutic inertia (TI) data was collected weekly from October 2022 to May 2023. Results: Major themes of prescribing barriers identified by physician interviews were patient non-adherence, lack of guideline-integrated practices, and lack of knowledge of single-pill combination agents (Table 1). Therapeutic inertia was examined for patients with high CVD risk and uncontrolled BP at a PACT visit. Baseline TI from June to October 2022 was 88.2% (128 of 145 patients had no change in antihypertensive therapy). Post-intervention TI was 88.4% (107 of 121 patients had no change in antihypertensive therapy). Conclusion: This study highlights the ongoing need to engage resident physicians with interactive tools to increase awareness of updated HTN guidelines. Identifying barriers to resident prescribing behaviors can be used to target interventions.