Effects of risk assessment and management programme for patients with hypertension (RAMP-HT) on cardiovascular disease risks and service utilization: 3-years’ experience

Abstract

Context: Cardiovascular disease (CVD) risk factors control is crucial for preventing complications in patients with hypertension (HT) while structured multi-disciplinary team care enhances CVD risk control. However, there are currently little evidence on the long-term effectiveness of programmes encompassing both components on the actual reduction of HT-related complications and service utilization. Objective: To evaluate the effectiveness of a structured multi-disciplinary CVD Risk-Assessment-and-Management-Programme(RAMP-HT) for HT patients. Design: Retrospective cohort study. Setting: Public primary care clinics in Hong Kong. Patients or Other Participants: 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 were clinically diagnosed with uncomplicated HT (i.e. without history of CVD or end-stage renal disease (ESRD)). Main and Secondary Outcome Measures: Main outcome measures were incidences of CVD, ESRD and all-cause mortality. Secondary outcome measures were frequencies of service utilization. Results: During a median follow-up period of 3 years, the cumulative incidences of CVD, ESRD and all-cause mortality among RAMP-HT participants were lower than that in usual care patients (Absolute risk reduction(ARR) for CVD:-2.11%;ESRD:-0.22%;mortality:-3.70%). Multivariable Cox proportional regressions were conducted and RAMP-HT participants were significantly associated with 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 all baseline characteristics. For service utilization, multivariable negative binomial regressions were performed and RAMP-HT participants were significantly associated with lower 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). Conclusions: The RAMP-HT was more effective than usual care in reducing the risks of CVD, ESRD and all-cause mortality after 3 years, and reducing use of emergency or tertiary care services. Further study is warranted to investigate whether RAMP-HT is cost-effective.