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Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients

Hypertension Research volume 43, pages 892–902 (2020)Cite this article

Abstract

Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (−3.4 mmHg; 95% CI −5.1, −1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively.

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Acknowledgements

This paper uses unit record data from the WellNet Program in the North Sydney region. The WellNet Program was initiated and funded by the WellNet partners, SCS, North Sydney PHN, Bupa, HCF, NIB and Teacher’s Health. We would especially like to thank Sonic Clinical Services for collecting and sharing the patient data and providing insights into the development and delivery of WellNet. The WellNet partners had no control or influence over the decision to submit the final paper for publication. We are particularly grateful to the health care teams of the participating primary care practices for their high-quality work in data collection. We wish to thank Munro Neville, Shima Ghassempour, Federico Girosi and Evan Atlantis for input and feedback provided for this study.

Funding

JRJ’s PhD scholarship was provided by the Capital Markets Cooperative Research Centre (Now Rozetta Institute). The funders did not have any role in the design, methods, analysis, or preparation of this paper.

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Authors and Affiliations

  1. Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia

    James Rufus John

  2. Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW, Australia

    James Rufus John

  3. School of Business, Western Sydney University, Parramatta, NSW, 2150, Australia

    W Kathy Tannous

  4. Sonic Clinical Services, Sydney, NSW, Australia

    Amanda Jones

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  1. James Rufus John
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Correspondence to James Rufus John.

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JRJ and KT have no competing interests. AJ is employed by SCS as the Operational Manager of Integrated Care and is responsible for the implementation of WellNet. However, SCS and WellNet partners had no control or influence over the decision to submit the final paper for publication.

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The study was reviewed by the Western Sydney University Human Research Ethics Committee (REDI Reference: H12215).

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John, J.R., Tannous, W.K. & Jones, A. Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients. Hypertens Res 43, 892–902 (2020). https://doi.org/10.1038/s41440-020-0431-3

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