The STITCH (Simplified Therapeutic Intervention to Control Hypertension) trial, funded by Pfizer Inc., involved introducing a simplified, four-step algorithm to 45 family practices in southwestern Ontario and comparing that with guidelines-based care, which can involve dozens of choices for doctors to sort through. The new protocol is not dissimilar to strategies employed in the 1960s.
In the STITCH group, 65 percent of patients reduced their blood pressure to the target level, compared with 53 percent in the guidelines group, a 12 percent absolute change in the proportion of patients who managed to control their hypertension.
While this trial involved mainly single-doctor practices, "the real impact of this study would not be in single practices but with the incorporation of the practices into health-care networks," Feldman noted.
A second study presented at the meeting, and also appearing in the Nov. 28 issue of the Journal of the American Medical Association, found that a statewide program in North Carolina cut the time it took to treat patients having a heart attack either with clot-busting drugs or percutaneous coronary intervention (PCI, also known as angioplasty) by up to 32 minutes.
With a heart attack, the sooner the patient's blocked arteries can be reopened, restoring blood flow to the heart, the better. AHA/American College of Cardiology guidelines recommend that drugs be delivered within 30 minutes and PCI accomplished with 90 minutes of the patient entering the hospital door (known as "door-to-balloon" time).
This program involved improvements such as naming a nurse coordinator and establishing a single telephone number to activate the catheterization lab team, at 65 hospitals throughout the state.
At hospitals that offered PCI, the percentage of patients receiving clot-busting therapy within ha
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