Structured Hypertension Education and Telephone Follow-up After Emergency Department Discharge: A Prospective Quality Improvement Initiative in Pakistan
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Background
Emergency department (ED) encounters may identify uncontrolled hypertension, but continuity after discharge is often weak. We evaluated a low-cost quality-improvement strategy combining standardized discharge education with early telephone follow-up in a resource-constrained setting.
Methods
This prospective, single-center pre-post quality improvement initiative enrolled 50 consecutive adults with diagnosed hypertension or elevated blood pressure at presentation who were clinically stable for discharge from the ED of Shaikh Zayed Hospital, Lahore, Pakistan, during August 2026. Participants received structured counseling on medication adherence, lifestyle measures, blood pressure (BP) monitoring, warning symptoms, and primary-care follow-up, followed by a telephone assessment approximately 2 weeks later. The primary estimand was mean within-participant systolic BP (SBP) reduction among participants who were reached and had complete numeric follow-up SBP and diastolic BP (DBP). We report bootstrap 95% confidence intervals (CIs), robust paired analyses, responder outcomes, and missing-data sensitivity analyses.
Results
Thirty-eight of 50 participants (76.0%) were reached and had complete paired BP measurements. In this paired cohort, mean SBP decreased from 164.4 (SD 20.3) to 132.6 (SD 12.4) mmHg, a mean reduction of 31.8 mmHg (95% bootstrap CI 24.4 to 39.3; P<0.001). Mean DBP decreased from 94.7 (SD 8.3) to 84.3 (SD 7.5) mmHg, a mean reduction of 10.4 mmHg (95% bootstrap CI 6.7 to 13.9; P<0.001). Strict BP control (<140/<90 mmHg) was achieved by 20/38 participants (52.6%; exact 95% CI 35.8% to 69.0%). SBP reduction of at least 10 mmHg occurred in 33/38 (86.8%), and DBP reduction of at least 5 mmHg in 26/38 (68.4%). Among reached participants with nonmissing responses, 73.0% reported medication adherence, 81.6% lifestyle modification, 77.1% primary-care follow-up, and 81.1% symptom improvement. Missing-data sensitivity analyses remained directionally consistent with lower follow-up BP.
Conclusions
Structured discharge education followed by early telephone contact was associated with substantial short-term within-participant BP reductions and high reported engagement with recommended care. Because the project lacked a concurrent control group, used a short follow-up interval, and had potential selection and measurement biases, the findings should not be interpreted as a causal treatment effect. Controlled evaluation with standardized BP measurement and longer follow-up is warranted.
