SUSTAINABLE HYPERTENSION MANAGEMENT IN PRIMARY HEALTH CARE IN SWEDEN

Objective: Most patients with hypertension in Sweden are managed within an overburdened and underfinanced primary health care system. To improve health outcomes and achieve cost-efficiency, sustainable, patient-centered, and team-based care models are urgently needed. This project aims to evaluate a new way of sustainable hypertension management in primary care (Sustainable Hypertension Management in Primary Health Care, SHIP-CARE, ClinicalTrials.gov ID: NCT06580613), starting with a pilot study at three Primary Health Care Centres (PHCCs) in southern Sweden. Design and method: The three PHCCs in the pilot study serve approximately 24,000 patients, 18% of whom are diagnosed with hypertension. Among these, only 37% currently achieve blood pressure levels below 140/90 mmHg, mirroring findings from previous Swedish studies. At the participating PHCCs, cardiovascular risk for all included hypertensive patients will be assessed using SCORE2/SCORE2-OP. The health care staff will receive training in hypertension treatment and an easy-to-follow treatment protocol. Non-physicians will lead group-based patient education on hypertension and life-style modifications. All patients will receive a home blood pressure monitor and can communicate with their assigned nurse digitally on medication adjustments, tests results, and follow-ups. The nurse will consult with the physician as needed, and regular face-to-face visits with the physician are reserved for patients at high cardiovascular risk or with end organ damage. Other patients will see a physician only when needed. All participants will be asked to complete questionnaires at baseline and at follow-up. Results: The main outcome for the pilot study is feasibility (recruitment of participants and loss to follow-up). Secondary outcomes will include changes in blood pressure and cardiovascular risk factors, patients’ and staff’s grade of satisfaction and knowledge, and health care costs. The pilot study will begin in January 2025, with a follow-up period of six months. Conclusions: The results of the pilot study will inform the design of a larger cluster-randomized controlled trial comparing PHCCs implementing SHIP-CARE with those using standard care.