A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients
A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients
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DOI：
10.1007/s11606-011-1794-6
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发表时间：
2011-11-01
影响因子：
5.7
通讯作者：
Levine, David M.
中科院分区：
文献类型：
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作者：
Cooper, Lisa A.;Roter, Debra L.;Levine, David M.
非裔美国人和低社会经济地位（SES）的人不成比例地受到高血压的影响，并且比不太脆弱的患者群体接受更少的以患者为中心的护理。此外，继续医学教育（CME）和患者激活干预措施很少被用于改善这些人群的护理过程。为了比较针对患者和医生的以患者为中心的干预措施与针对服务不足群体的最小干预措施的有效性，2002年1月至2005年8月进行了随机对照试验。在巴尔的摩，马里兰州的14个城市，以社区为基础的做法，在3个月和12个月的患者随访。41名初级保健医生和279名高血压患者。医生沟通技能培训和社区卫生工作者的患者辅导。医生沟通行为。患者对医生参与决策（PDM）、患者参与护理（PIC）、报告的药物依从性的评分;收缩压和舒张压（BP）以及BP控制。与对照组相比，接受过培训的医生的访视表现出更积极的沟通变化评分（-0.52对比-0.82，p = 0.04）。在12个月时，患者+医生强化组与最小干预组相比，在医生PDM的患者报告中显示出显著更大的改善（β = +6.20 vs.-5.24，p = 0.03）和与医生促进相关的PIC维度（β = +0.22 vs.-0.17，p = 0.03）和信息交换（β = +0.32 vs.-0.22，p = 0.005）。对于总体患者样本，患者依从性和血压控制的改善在各组之间没有差异。然而，在基线时高血压不受控制的患者中，所有干预组（患者+医生强化治疗组）的患者均观察到收缩压无显著降低。（-13.2 mmHg），医生密集/患者轻微（-10.6 mmHg），患者密集型/医生最小（-16.8 mmHg），与患者+医生最小值组相比（-2.0 mmHg）。增强医生沟通技巧和激活患者参与其护理的干预措施积极影响以患者为中心的沟通，患者对护理参与的感知，并可能改善城市非洲裔美国人和低SES高血压患者的收缩压。
African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations.To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups.Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland.Forty-one primary care physicians and 279 hypertension patients.Physician communication skills training and patient coaching by community health workers.Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control.Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p = 0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (beta = +6.20 vs. -5.24, p = 0.03) and PIC dimensions related to doctor facilitation (beta = +0.22 vs. -0.17, p = 0.03) and information exchange (beta = +0.32 vs. -0.22, p = 0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg).Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.