Effects of the risk assessment and management programme for patients with hypertension (RAMP-HT) on hypertension-related complications and service utilization - 3-years' experience

Abstract

Introduction: Cardiovascular disease (CVD) risk factors control is crucial for preventing complications in patients with hypertension (HT). However, there are currently little evidence on the long-term effectiveness of structured, multi-disciplinary CVD risk management programmes on the actual reduction of HT-related complications and service utilization. This study aims at evaluating the effectiveness of the Risk-Assessment-and-Management-Programme (RAMP-HT) for HT patients in the primary care setting in Hong Kong. Methods: A retrospective cohort study of 37,366 RAMP-HT participants and the same number of propensity-score-matched HT patients receiving usual care from public primary care clinics between October 2011 and March 2013 were included. All patients did not have any HT-related complications (i.e. without history of CVD or end-stage renal disease (ESRD)) at baseline. The effects of RAMP-HT on HT-related complications, all-cause mortality and health service utilizations were evaluated using Cox proportional hazards regression and negative binomial regression models, respectively. Results: During a median follow-up period of 3 years, RAMP-HT participants had 16.2% (Hazard ratio (HR):0.838; P<0.001), 23.7% (HR:0.763; P=0.045) and 49.5% (HR:0.505; P<0.001) reductions in the risks of CVD, ESRD and mortality compared with usual care group, respectively, after adjusting for all baseline characteristics; the reduction was statistically significant. In terms of service utilization, RAMP-HT participants had significantly less episodes of overnight hospitalization (Incidence rate ratio (IRR):0.717; P<0.001), attendance at emergency department (IRR:0.800; P<0.001) and specialist-outpatient clinic (IRR:0.926; P<0.001), but more general outpatient clinic visits (IRR:1.012; P<0.001). Discussion: The RAMP-HT was more effective than usual care in reducing the risks of CVD, ESRD and all-cause mortality of Chinese primary care patients with uncomplicated HT after 3 years, and reducing their use of emergency, secondary or tertiary care services in Hong Kong.