Clinical InvestigationHypertensionPatient education and provider decision support to control blood pressure in primary care: A cluster randomized trial
Section snippets
Design, setting, and recruitment
The study was a longitudinal cluster randomized trial; the interventions occurred at 2 levels (provider and patient), and patients were nested within providers and followed over time.
Patients
The patients' mean age was 63 years, 98% were male, and 40% were African American (see Table I). A significant percent of the sample reported no exercise (44%) in the last week, 25% were current smokers, and 37% had diabetes. Baseline mean SBP was 140 mm Hg (SD = 18), DBP was 76 mm Hg (SD = 11), and 40% of the sample had their BP under control at baseline.
Primary analyses
Over the 2 years of the intervention, there were no significant differences in amount of change in BP control in each of the intervention
Discussion
We examined the effects of both a patient behavioral intervention delivered by telephone to patients along with a provider decision support intervention directed at providers in an attempt to improve overall BP control among adults with hypertension treated in primary care. We did not observe a significant improvement in BP control across the 3 intervention groups relative to the reminder control group over the 2-year follow-up. In secondary analyses, we observed improvements in BP control
Conclusion
Computer-based decision support patient management system delivered at the point of care did not result in significant improvements in BP control, whereas a telephone-delivered patient intervention resulted in meeting our a priori specified clinically significant end point; this difference was not statistically significant from the control group. A brief nurse-administered telephone intervention may have a clinical effect on BP control rates in a primary care setting. With 65 million of the US
Disclosures
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Acknowledgements
We wish to thank the EON Group at Stanford Medical Informatics, the ATHENA Group at VA Palo Alto Health Care System, and Brian B. Hoffman, MD, collaborators on developing the ATHENA Decision Support System. Earlier results were presented at the 2005 American Heart Association Conference, Dallas, TX.
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Dr. George A. Mensah served as guest editor for this manuscript.