{"id":"https://openalex.org/W7212288197","doi":"https://doi.org/10.64898/2026.09.07.26361893","title":"Structured Hypertension Education and Telephone Follow-up After Emergency Department Discharge: A Prospective Quality Improvement Initiative in Pakistan","display_name":"Structured Hypertension Education and Telephone Follow-up After Emergency Department Discharge: A Prospective Quality Improvement Initiative in Pakistan","publication_year":2026,"publication_date":"2026-09-10","ids":{"openalex":"https://openalex.org/W7212288197","doi":"https://doi.org/10.64898/2026.09.07.26361893"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.07.26361893","doi":"https://doi.org/10.64898/2026.09.07.26361893","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26361893","pdf_url":null,"source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.64898/2026.09.07.26361893","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5151333212","display_name":"Mubarra Aqeel","orcid":"https://orcid.org/0009-0009-9881-0290","observed_orcids":["https://orcid.org/0009-0009-9881-0290"]},"institutions":[{"id":"https://openalex.org/I2801114866","display_name":"Shaikh Zayed Hospital","ror":"https://ror.org/002tz8e96","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I2801114866"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Mubarra Aqeel","raw_affiliation_strings":["Emergency Department, Shaikh Zayed Hospital, Lahore, Pakistan"],"raw_orcid":"https://orcid.org/0009-0009-9881-0290","affiliations":[{"raw_affiliation_string":"Emergency Department, Shaikh Zayed Hospital, Lahore, Pakistan","institution_ids":["https://openalex.org/I2801114866"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5113925062","display_name":"Muhammad Hashmi","orcid":"https://orcid.org/0009-0001-4901-7562","observed_orcids":["https://orcid.org/0009-0001-4901-7562"]},"institutions":[{"id":"https://openalex.org/I4210162682","display_name":"Sir Ganga Ram Hospital","ror":"https://ror.org/01ghxpd93","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I4210162682"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Muhammad Sarmad Waqar Hashmi","raw_affiliation_strings":["Sir Ganga Ram Hospital, Lahore, Pakistan"],"raw_orcid":"https://orcid.org/0009-0001-4901-7562","affiliations":[{"raw_affiliation_string":"Sir Ganga Ram Hospital, Lahore, Pakistan","institution_ids":["https://openalex.org/I4210162682"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5099524729","display_name":"Uswah Shoaib","orcid":"https://orcid.org/0009-0008-8893-8269","observed_orcids":["https://orcid.org/0009-0008-8893-8269"]},"institutions":[{"id":"https://openalex.org/I2800672702","display_name":"Combined Military Hospital","ror":"https://ror.org/05mya2w74","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I2800672702"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Uswah Shoaib","raw_affiliation_strings":["Department of Community Medicine, Combined Military Hospital, Lahore, Pakistan"],"raw_orcid":"https://orcid.org/0009-0008-8893-8269","affiliations":[{"raw_affiliation_string":"Department of Community Medicine, Combined Military Hospital, Lahore, Pakistan","institution_ids":["https://openalex.org/I2800672702"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5114105024","display_name":"Zarwa Rashid","orcid":"https://orcid.org/0000-0003-4876-5726","observed_orcids":["https://orcid.org/0000-0003-4876-5726"]},"institutions":[{"id":"https://openalex.org/I142016965","display_name":"King Edward Medical University","ror":"https://ror.org/02rrbpf42","country_code":"PK","type":"education","lineage":["https://openalex.org/I142016965"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Zarwa Rashid","raw_affiliation_strings":["King Edward Medical University, Lahore, Pakistan"],"raw_orcid":"https://orcid.org/0000-0003-4876-5726","affiliations":[{"raw_affiliation_string":"King Edward Medical University, Lahore, Pakistan","institution_ids":["https://openalex.org/I142016965"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5112806363","display_name":"Ali Shan Hafeez","orcid":"https://orcid.org/0009-0000-8015-033X","observed_orcids":["https://orcid.org/0009-0000-8015-033X"]},"institutions":[{"id":"https://openalex.org/I4405261280","display_name":"CMH Multan Institute of Medical Sciences","ror":"https://ror.org/051wpfh59","country_code":"PK","type":"education","lineage":["https://openalex.org/I4405261280"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Ali Shan Hafeez","raw_affiliation_strings":["CMH Multan Institute of Medical Sciences, Multan, Pakistan"],"raw_orcid":"https://orcid.org/0009-0000-8015-033X","affiliations":[{"raw_affiliation_string":"CMH Multan Institute of Medical Sciences, Multan, Pakistan","institution_ids":["https://openalex.org/I4405261280"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10144","display_name":"Blood Pressure and Hypertension Studies","score":0.9961000084877014,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10144","display_name":"Blood Pressure and Hypertension Studies","score":0.9961000084877014,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11620","display_name":"Medication Adherence and Compliance","score":0.000699999975040555,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/hypertension","display_name":"hypertension","score":0.9089999794960022},{"id":"https://openalex.org/keywords/emergency-department-discharge","display_name":"emergency department discharge","score":0.9509999752044678},{"id":"https://openalex.org/keywords/discharge-education","display_name":"discharge education","score":0.8119999766349792},{"id":"https://openalex.org/keywords/telephone-follow-up","display_name":"telephone follow-up","score":0.9890000224113464},{"id":"https://openalex.org/keywords/blood-pressure-control","display_name":"blood pressure control","score":0.6690000295639038},{"id":"https://openalex.org/keywords/treatment-adherence","display_name":"medication adherence","score":0.9390000104904175},{"id":"https://openalex.org/keywords/lifestyle-modification","display_name":"lifestyle modification","score":0.9620000123977661},{"id":"https://openalex.org/keywords/primary-care-follow-up","display_name":"primary care follow-up","score":0.7509999871253967},{"id":"https://openalex.org/keywords/resource-limited-settings","display_name":"resource-limited settings","score":0.7139999866485596},{"id":"https://openalex.org/keywords/quality-improvement","display_name":"quality improvement","score":0.7829999923706055},{"id":"https://openalex.org/keywords/pakistan","display_name":"Pakistan","score":0.460999995470047},{"id":"https://openalex.org/keywords/low-cost-interventions","display_name":"low-cost interventions","score":0.3880000114440918},{"id":"https://openalex.org/keywords/continuity-of-care","display_name":"continuity of care","score":0.6150000095367432},{"id":"https://openalex.org/keywords/blood-pressure-monitoring","display_name":"blood pressure monitoring","score":0.4050000011920929},{"id":"https://openalex.org/keywords/patient-counseling","display_name":"patient counseling","score":0.3540000021457672},{"id":"https://openalex.org/keywords/responder-analysis","display_name":"responder analysis","score":0.5130000114440918},{"id":"https://openalex.org/keywords/bootstrap-confidence-intervals","display_name":"bootstrap confidence intervals","score":0.6520000100135803}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9174000024795532},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.7318000197410583},{"id":"https://openalex.org/C84393581","wikidata":"https://www.wikidata.org/wiki/Q82642","display_name":"Blood pressure","level":2,"score":0.7081999778747559},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.5874000191688538},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5360000133514404},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.5292999744415283},{"id":"https://openalex.org/C2777929519","wikidata":"https://www.wikidata.org/wiki/Q7144988","display_name":"Patient education","level":2,"score":0.5076000094413757},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.4000000059604645},{"id":"https://openalex.org/C2775944032","wikidata":"https://www.wikidata.org/wiki/Q22907659","display_name":"Patient satisfaction","level":2,"score":0.35740000009536743},{"id":"https://openalex.org/C57900726","wikidata":"https://www.wikidata.org/wiki/Q492905","display_name":"Diastole","level":3,"score":0.3522000014781952},{"id":"https://openalex.org/C2778834376","wikidata":"https://www.wikidata.org/wiki/Q7696504","display_name":"Telephone interview","level":2,"score":0.3452000021934509},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.3231000006198883},{"id":"https://openalex.org/C3020357261","wikidata":"https://www.wikidata.org/wiki/Q25304032","display_name":"Hypertension treatment","level":3,"score":0.3188999891281128},{"id":"https://openalex.org/C2776181593","wikidata":"https://www.wikidata.org/wiki/Q2296401","display_name":"Telephone call","level":2,"score":0.3176000118255615},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.3174000084400177},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.3125999867916107},{"id":"https://openalex.org/C2992395903","wikidata":"https://www.wikidata.org/wiki/Q814232","display_name":"Telephone survey","level":2,"score":0.2872999906539917},{"id":"https://openalex.org/C203092338","wikidata":"https://www.wikidata.org/wiki/Q1340863","display_name":"Clinical endpoint","level":3,"score":0.2842999994754791},{"id":"https://openalex.org/C2781158071","wikidata":"https://www.wikidata.org/wiki/Q55379489","display_name":"Primary care physician","level":3,"score":0.2766999900341034},{"id":"https://openalex.org/C3017604501","wikidata":"https://www.wikidata.org/wiki/Q16784869","display_name":"Home study","level":2,"score":0.25380000472068787}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.07.26361893","doi":"https://doi.org/10.64898/2026.09.07.26361893","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26361893","pdf_url":null,"source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.07.26361893","doi":"https://doi.org/10.64898/2026.09.07.26361893","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26361893","pdf_url":null,"source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/clinical-trial","display_name":"Clinical Trial"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":12,"referenced_works":["https://openalex.org/W1968280559","https://openalex.org/W2128030991","https://openalex.org/W2133107047","https://openalex.org/W2973680119","https://openalex.org/W4319062578","https://openalex.org/W4384338025","https://openalex.org/W4385264616","https://openalex.org/W4386757978","https://openalex.org/W4399091810","https://openalex.org/W4399920872","https://openalex.org/W4407500193","https://openalex.org/W4412694315"],"related_works":["https://openalex.org/W4409728681","https://openalex.org/W3135584863","https://openalex.org/W2246673041","https://openalex.org/W4412855079","https://openalex.org/W3042811334","https://openalex.org/W2895218478","https://openalex.org/W4403398051","https://openalex.org/W2804468861","https://openalex.org/W4285493562","https://openalex.org/W3026578335"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Emergency":[2],"department":[3],"(ED)":[4],"encounters":[5],"may":[6],"identify":[7],"uncontrolled":[8],"hypertension,":[9],"but":[10],"continuity":[11],"after":[12],"discharge":[13,25,61,281],"is":[14,343],"often":[15],"weak.":[16],"We":[17,126],"evaluated":[18],"a":[19,32,94,172,197,307,312,330],"low-cost":[20],"quality-improvement":[21],"strategy":[22],"combining":[23],"standardized":[24,337],"education":[26,282],"with":[27,47,252,275,290,300,336],"early":[28,285],"telephone":[29,95,286],"follow-up":[30,120,277,314,342],"in":[31,235,246],"resource-constrained":[33],"setting.":[34],"Methods":[35],"This":[36],"prospective,":[37],"single-center":[38],"pre-post":[39],"quality":[40],"improvement":[41],"initiative":[42],"enrolled":[43],"50":[44,145],"consecutive":[45],"adults":[46],"diagnosed":[48],"hypertension":[49],"or":[50],"elevated":[51],"blood":[52,83],"pressure":[53,84],"at":[54,230,242],"presentation":[55],"who":[56,113],"were":[57,114,148],"clinically":[58],"stable":[59],"for":[60],"from":[62,163,188],"the":[63,304,323],"ED":[64],"of":[65,144,175,200,229,241],"Shaikh":[66],"Zayed":[67],"Hospital,":[68],"Lahore,":[69],"Pakistan,":[70],"during":[71],"August":[72],"2026.":[73],"Participants":[74],"received":[75],"structured":[76],"counseling":[77],"on":[78],"medication":[79,257],"adherence,":[80,258],"lifestyle":[81,260],"measures,":[82],"(BP)":[85],"monitoring,":[86],"warning":[87],"symptoms,":[88],"and":[89,116,122,138,150,238,265,296,316,320,340],"primary-care":[90,263],"follow-up,":[91,264],"followed":[92,283],"by":[93,217,284],"assessment":[96],"approximately":[97],"2":[98],"weeks":[99],"later.":[100],"The":[101],"primary":[102],"estimand":[103],"was":[104,215,288],"mean":[105,160,173,198],"within-participant":[106,293],"systolic":[107],"BP":[108,124,154,211,294,338],"(SBP)":[109],"reduction":[110,174,199,228,240],"among":[111],"participants":[112,146,219,251],"reached":[115,149,250],"had":[117,151,317],"complete":[118,152],"numeric":[119],"SBP":[121,161,227],"diastolic":[123],"(DBP).":[125],"report":[127],"bootstrap":[128,179,204],"95%":[129,222],"confidence":[130],"intervals":[131],"(CIs),":[132],"robust":[133],"paired":[134,153,158],"analyses,":[135],"responder":[136],"outcomes,":[137],"missing-data":[139],"sensitivity":[140,270],"analyses.":[141],"Results":[142],"Thirty-eight":[143],"(76.0%)":[147],"measurements.":[155],"In":[156],"this":[157],"cohort,":[159],"decreased":[162,187],"164.4":[164],"(SD":[165,169,190,194],"20.3)":[166],"to":[167,182,192,207,225],"132.6":[168],"12.4)":[170],"mmHg,":[171,196],"31.8":[176],"mmHg":[177,202,233,245],"(95%":[178,203],"CI":[180,205,223],"24.4":[181],"39.3;":[183],"P<0.001).":[184,209],"Mean":[185],"DBP":[186,239],"94.7":[189],"8.3)":[191],"84.3":[193],"7.5)":[195],"10.4":[201],"6.7":[206],"13.9;":[208],"Strict":[210],"control":[212,309],"(<140/<90":[213],"mmHg)":[214],"achieved":[216],"20/38":[218],"(52.6%;":[220],"exact":[221],"35.8%":[224],"69.0%).":[226],"least":[231,243],"10":[232],"occurred":[234],"33/38":[236],"(86.8%),":[237],"5":[244],"26/38":[247],"(68.4%).":[248],"Among":[249],"nonmissing":[253],"responses,":[254],"73.0%":[255],"reported":[256,298],"81.6%":[259],"modification,":[261],"77.1%":[262],"81.1%":[266],"symptom":[267],"improvement.":[268],"Missing-data":[269],"analyses":[271],"remained":[272],"directionally":[273],"consistent":[274],"lower":[276],"BP.":[278],"Conclusions":[279],"Structured":[280],"contact":[287],"associated":[289],"substantial":[291],"short-term":[292],"reductions":[295],"high":[297],"engagement":[299],"recommended":[301],"care.":[302],"Because":[303],"project":[305],"lacked":[306],"concurrent":[308],"group,":[310],"used":[311],"short":[313],"interval,":[315],"potential":[318],"selection":[319],"measurement":[321,339],"biases,":[322],"findings":[324],"should":[325],"not":[326],"be":[327],"interpreted":[328],"as":[329],"causal":[331],"treatment":[332],"effect.":[333],"Controlled":[334],"evaluation":[335],"longer":[341],"warranted.":[344]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-09-12T00:00:00"}