Primary care evaluation of the hypertensive patient management in specialized care after derivation (DERIVA-2 Study)

Introduction: To know the opinion/evaluation of the primary care physicians (PCPH) of the received information about patients that were attended in specialized care (SC). Design: Cross-sectional study. Location: Performed nationwide in primary care centers. Participants: Researchers from the primary care network. Methods: We used the SEH-LELHA derivation criteria guidelines, plus an ad hoc survey that included demographic and anthropometric data, blood pressure levels, and the main reason for derivation to SC at the baseline and final (post-derivation) visit. In addition, time deployed for the study of every patient, changes in diagnosis and treatment, type of follow-up, issues throughout the derivation process and assessment of the medical referred to the PCPH were evaluated. Results: With participation of 578 researchers from primary, the study included 1715 patients aged 60.7 +/- 13.3 years, 62.7% male. Patients were taking 2.3 +/- 1.2 (range 0-10) antihypertensive drugs pre-referral and 2.5 +/- 1.2 (0-9) after derivation. Blood pressure levels changed from 166 +/- 21.6 / 97.7 +/- 12.6 mmHg to 143 +/- 14.4 / 85.5 +/- 10.5 mmHg. The number of controlled patients (BP < 140 and < 90 mmHg) increased from 5.8% to 32.2%. Time between pre- and post-derivation visit was 72 +/- 64 days (median 57 days, IQ26-99). The PCPH received a medical report in 80.3% of cases, 76.9% with an explanation of the results of the complementary tests, 75.8% with additional information or a reasoning of treatment and in 71% of cases information about the patient future management. 63% of PCPH were fully agreed with the management of the specialist, 29% agree and 2% strongly disagree. The derivation was evaluated as effective or very effective in 86% of patients and no effective in 9%. Conclusions: Communication between AE and SC in HTA is valued satisfactorily by MAP. However there is still room for improvement in the process. (C) 2017 Published by Elsevier Espana, S.L.U.