Case study

Blackpool: identify and treat people with undiagnosed high blood pressure

A project to identify and treat people with existing but undiagnosed hypertension.

• From: Public Health England
• Published: 18 November 2014

Project included:

• working with local general practice to identify people with a high blood pressure recording who have not received follow up intervention
• following up those people known by general practice to have hypertension who are not accessing medication or effectively managed
• holding community blood pressure awareness and testing events
• running an awareness-raising publicity and media campaign

The project resulted in 2,679 patients being added to GP hypertension registers (which will potentially prevent around 70 cardiovascular events per year). The size of GP hypertension registers rose by an average of 9.95%.

2,000 more people aged 45 years and over had a recent blood pressure reading entered onto their records, and there was an increase of 5% in the prescribing of anti-hypertensive drugs.

Contact person

Dr Arif Rajpura, Director of Public Health, Blackpool Council

Region

Cumbria and Lancashire

Location

Blackpool

Partner organisations

Blackpool CCG, Blackpool Teaching Hospitals NHS Trust and Blackpool Council

Target population

• people at risk of hypertension
• who have been diagnosed with hypertension but whose condition is managed sub-optimally

Aims

• to reduce mortality from cardiovascular disease (CVD) and to reduce inequalities in mortality within the population
• to raise public awareness of the importance of managing blood pressure to prevent ill health

Programme structure

Planned to screen 10,000 hard to engage people ages 40 to 70 years in the general population.

Identified target groups were:

• men aged 45 to 60 in low paid work, sole traders or in small or medium size enterprises (SME)
• men aged 45 to 60, unemployed
• women aged 50 to 60 in low paid work, sole traders or in small or medium size enterprises (SME)
• women aged 50 to 60, unemployed

Worked with local general practice to identify people with a high blood pressure (BP) recording who have not received follow up intervention, and follow up those known to the practice to have hypertension who are not accessing medication, or who were not effectively managed.

The Wellness Service Community team held a number of community blood pressure awareness and testing events.

An awareness-raising media campaign was undertaken.

Activity to date

Worked with local general practice to identify patients on practice registers:

• with any chronic disease plus hypertension, where their condition is not currently managed effectively (sub-optimally) and help them improve the management of their condition
• with existing hypertension where their condition is not currently managed effectively and help them improve the management of their condition
• with recorded high blood pressure who did not have follow up blood pressure monitoring, and who are not on the practice register, and ensure they receive the care required
• who are in an at-risk group but have not attended for a blood pressure check in the past 3 years, and pursue and encourage them to attend the practice to record their blood pressure

The Wellness Service Community team held 87 community blood pressure events from January to September 2013.

At these events, we performed 1,616 blood pressure checks on Blackpool registered patients. 33% of these (527) had one or both of their readings raised and were referred to their GP.

Bill boards, trams and buses carried advertisements for the events and a local shopping centre ran a video 6 times an hour for 6 months. TV and radio reports about the campaign included:

• BBC News
• BBC Breakfast
• The Politics Show
• ITV Daybreak
• Radio Lancashire
• Radio Wave

Outcome measures

• number of patients added to GP hypertension registers
• number of patients over 45 years old with a blood pressure recording in the preceding 5 years • prescribing levels of anti-hypertensive drugs

Outcomes In the first 12 months of the project

1. 2679 patients were added to hypertension registers, which will potentially prevent around 70 cardiovascular events including heart attacks and strokes per year.

2. Average increase in hypertension register size across all practices is 9.95%

3. Achievement against Records 11, ‘The blood pressure of patients aged 45 years and over is recorded in the preceding 5 years for at least 65% of patients’ has increased by 2.34% since the start of the project from 88.96% to 91.30% which equates to approx. 2,000 more people in this age group with a recent blood pressure reading entered onto their records. Achievements against this indicator did slow down in the second 6 months of the project with only 11 out of 23 practices continuing to improve

4. Epact data for July to September 2013 compared to January to March 2013 (before the programme) shows an increase in prescribing of anti-hypertensive drugs of 4.9% with an expected trend towards prescribing as recommended by NICE.

5. Hypertension prevalence across Blackpool has increased from 15.31% to 17.83% (↑2.52%)

Estimated NESTA Rating:: 2

Level 2 (Promising): The project can capture data that shows positive change, but cannot demonstrate causality link.

Published 18 November 2014