Abstract
Objectives
Hypertension is a leading cause of morbidity and mortality. The emergency department
(ED) frequently serves populations with unmet health needs and could have a greater
and more systematic role in secondary prevention for hypertension. This study sought
to determine, among hypertensive patients discharged from the ED, the frequency that
patients 1) received hypertension-specific education, and 2) followed-up with a primary
care provider. We secondarily assessed participant beliefs about hypertension.
Methods
This non-experimental, observational study enrolled a convenience sample of consenting
patients with asymptomatic, markedly elevated blood pressure (systolic ≥160 mmHg or
diastolic ≥100 mmHg) with medium to low triage acuity discharged from an urban, academic
ED. Discharge instructions were assessed through chart review. Patients followed up
per their normal routine without intervention. Participants were interviewed by phone
two to four weeks after ED discharge to ascertain outpatient follow-up and describe
beliefs about hypertension.
Results
From April through June 2014, 200 patients were approached, of whom 90 were enrolled.
Of these, 77% of patients reported a previous diagnosis of hypertension, and 60% reported
current treatment with antihypertensive medications. Five patients (5.5%) received
written instructions at discharge addressing hypertension, although 59 (65.6%) reported
that they were informed about their elevated blood pressure during the ED visit. Follow-up
with a primary care provider within 2–4 weeks of discharge was completed in 57% of
cases. None of the patients who received hypertension-specific discharge instructions
completed follow-up.
Conclusions
Over half of markedly hypertensive patients discharged from the ED followed up with
primary care within four weeks. Nonetheless, missed opportunities for improved secondary
prevention among ED patients with hypertension are common. There is an urgent need
for evidence-based interventions to assist emergency departments in addressing this
health threat.
Keywords
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Article Info
Publication History
Published online: October 04, 2018
Accepted:
September 17,
2018
Received in revised form:
August 23,
2018
Received:
July 31,
2018
Identification
Copyright
© 2018 Published by Elsevier Inc.
