Testing interventions to reduce clinical inertia in the treatment of hypertension: rationale and design of a pragmatic randomized controlled trial.
Testing interventions to reduce clinical inertia in the treatment of hypertension: rationale and design of a pragmatic randomized controlled trial.
复制标题
测试干预措施以减少高血压治疗中的临床惯性：实用随机对照试验的基本原理和设计。
DOI：
10.1016/j.ahj.2023.11.005
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发表时间：
2024
影响因子：
4.8
通讯作者：
Choudhry,Nit
中科院分区：
文献类型：
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作者：
Haff,Nancy;Sreedhara,SushamaKattinakere;Wood,Wendy;Yom-Tov,Elad;Horn,DanielM;Hoover,Melissa;Low,Greg;Lauffenburger,JulieC;Chaitoff,Alexander;Russo,Massimiliano;Hanken,Kaitlin;Crum,KatherineL;Fontanet,ConstanceP;Choudhry,Nit
背景临床惰性，或未能加强治疗时，指示，导致次优的血压控制。克服惰性和增加抗高血压处方的干预措施取得了一定的成功，部分原因是其有效性根据提供者、患者或提供者-患者互动的特征而变化。了解每个干预措施是最有效的，可以帮助目标的干预措施，从而增加其impact.MethodsThis三臂，随机试验测试的有效性，2干预措施，以减少临床惰性高血压处方相比，通常的护理。45名照顾需要强化治疗的高血压患者的初级保健提供者（PCP）完成了评估行为特征的基线调查，并随机分为三组：1）药剂师电子咨询，其中临床药剂师在即将到来的访视之前向PCP提供针对患者的高血压药物管理建议，2）社会规范仪表板，显示PCP的高血压控制率与同龄人相比，或3）家庭护理（无干预）。主要结局是高血压治疗强化率。我们将比较研究组之间的结果，然后评估供应商，患者，他们的临床相互作用和干预responsibility. ResultsForty五个初级保健提供者的特征之间的关联登记和随机：社会规范仪表板组中有16名提供者和173名患者，药剂师电子咨询组中有15名提供者和143名患者，14名提供者和150名患者在常规护理组。平均而言，平均患者年龄为64岁，47%为女性，73%为白色。基线人口统计学和患者的临床特征是相似的武器，除了更多的西班牙裔患者在常规护理臂和最少的药剂师电子咨询arm.ConclusionsThis研究可以帮助确定干预措施，以减少惯性高血压护理和潜在的识别患者的特点，供应商，或患者与供应商的互动，以了解谁的每一个干预措施将是最有益的。RegistrationClinicaltrials.gov
BackgroundClinical inertia, or failure to intensify treatment when indicated, leads to suboptimal blood pressure control. Interventions to overcome inertia and increase antihypertensive prescribing have been modestly successful in part because their effectiveness varies based on characteristics of the provider, the patient, or the provider-patient interaction. Understanding for whom each intervention is most effective could help target interventions and thus increase their impact.MethodsThis three-arm, randomized trial tests the effectiveness of 2 interventions to reduce clinical inertia in hypertension prescribing compared to usual care. Forty five primary care providers (PCPs) caring for patients with hypertension in need of treatment intensification completed baseline surveys that assessed behavioral traits and were randomized to one of three arms: 1) Pharmacist e-consult, in which a clinical pharmacist provided patient-specific recommendations for hypertension medication management to PCPs in advance of upcoming visits, 2) Social norming dashboards that displayed PCP's hypertension control rates compared to those of their peers, or 3) Usual care (no intervention). The primary outcome was the rate of intensification of hypertension treatment. We will compare this outcome between study arms and then evaluate the association between characteristics of providers, patients, their clinical interactions, and intervention responsiveness.ResultsForty-five primary care providers were enrolled and randomized: 16 providers and 173 patients in the social norming dashboards arm, 15 providers and 143 patients in the pharmacist e-consult arm, and 14 providers and 150 patients in the usual care arm. On average, the mean patient age was 64 years, 47% were female, and 73% were white. Baseline demographic and clinical characteristics of patients were similar across arms, with the exception of more Hispanic patients in the usual care arm and fewest in the pharmacist e-consult arm.ConclusionsThis study can help identify interventions to reduce inertia in hypertension care and potentially identify the characteristics of patients, providers, or patient-provider interactions to understand for whom each intervention would be most beneficial.Trial RegistrationClinicaltrials.gov (NCT, Registered: NCT04603560)