The veterans' study to improve the control of hypertension (V-STITCH): Design and methodology
The veterans' study to improve the control of hypertension (V-STITCH): Design and methodology
复制标题
DOI：
10.1016/j.cct.2004.12.006
复制
发表时间：
2005-04-01
影响因子：
2.2
通讯作者：
Oddone, EZ
中科院分区：
文献类型：
--
作者：
Bosworth, HB;Olsen, MK;Oddone, EZ
背景：在6000万患有高血压的美国人中，只有大约31%的人血压(BP)在控制范围内(<；140/90 mm Hg)。尽管有高血压的破坏性影响和循证的血压目标值的可用性，但改善血压控制的干预措施取得的成功有限。目的：正在进行一项裂区设计的随机对照卫生服务干预试验，以改善血压控制。这项为期4年的试验在诊断为高血压的退伍军人中评估了患者和提供者在初级保健环境中的干预。方法：在整群随机的基础上，达勒姆VAMC初级保健诊所的30名初级保健提供者被随机分配接受提供者干预或对照。提供者干预是一个特定于患者的电子生成的高血压决策支持系统(DSS)，在每个患者就诊时向提供者提供基于指南的建议，旨在提高指南的一致性治疗。对于这些提供者，他们的高血压患者样本(n=588)被随机分配到接受电话管理的患者干预或常规护理。患者干预结合了患者的需求评估，并包括量身定制的行为和教育模块，以促进药物依从性和改善特定的健康行为。所有模块通过电话每两个月交付一次，为期24个月。在这项试验中，主要结果是患者达到BP的比例
Background: Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (< 140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, interventions to improve BP control have had limited success.Objectives: A randomized controlled health services intervention trial with a split-plot design is being conducted to improve BP control. This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans.Methods: In a cluster-randomization, 30 primary care providers in the Durham VAMC Primary Care Clinic were randomly assigned to receive the provider intervention or control. The provider intervention is a patient-specific electronically generated hypertension decision support system (DSS) delivering guideline-based recommendations to the provider at each patient's visit, designed to improve guideline-concordant therapy. For these providers, a sample of their hypertensive patients (n = 588) was randomly assigned to receive a telephone-administered patient intervention or usual care. The patient intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. All modules are delivered over the telephone bi-monthly for 24 months. In this trial, the primary outcome is the proportion of patients who achieve a BP