[Durability of the effects of a quality improvement intervention in hypertensive patients on long-term follow-up (CICLO-RISK study)].
OBJECTIVE
To evaluate the durability of the effects achieved with a quality improvement intervention on cardiovascular risk factors and cardiovascular risk, as intermediate outcomes, in hypertensive patients on long-term follow-up long time primary health care.


DESIGN
Quasi-experimental study.


SETTING
Two urban primary care health centres.


PARTICIPANTS
The study included 419 and 430 hypertensive patients in the intervention (IG) and control group (CG), respectively.


INTERVENTIONS
Quality improvement intervention consisted of a combined program including, an audit, feedback, training sessions on the main cardiovascular risk factors clinical guidelines.


MEASUREMENTS
Evaluation of intermediate outcomes (blood pressure, LDL-cholesterol, HbA(1c), smoking, BMI and cardiovascular risk), were measured in both groups in March 2002, 2004 and 2006.


RESULTS
The mean of the durability effect (differences between IG and CG means) was: systolic blood pressure decreased from 8.9 to 4.3 and the diastolic from 3.9 to 2.3 mmHg (p<0.05). LDL-cholesterol decreased from 10 to 1.1mg/dl (p>0.05). Coronary risk fell from 2 to 1.2 percentage points and cardiovascular mortality risk from 0.6 to 0.4 percentage points (p<0.05). The percentage of patients with blood pressure<140/90 mmHg and BMI<30 lost statistical significance in the end evaluation and only remains in the percentage of patients with coronary risk less than 20% in the 2004 and 2006 results.


CONCLUSIONS
Quality improvement intervention was associated with reductions in cardiovascular risk factors and cardiovascular risk in post intervention evaluations with a tendency to decrease the effect achieved in the end evaluation.