Reducing Clinical Inertia in Hypertension Treatment: A Pragmatic Randomized Controlled Trial
Reducing Clinical Inertia in Hypertension Treatment: A Pragmatic Randomized Controlled Trial
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DOI：
10.1111/j.1751-7176.2012.00607.x
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发表时间：
2012-05-01
影响因子：
2.8
通讯作者：
Denberg, Thomas D.
中科院分区：
文献类型：
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作者：
Huebschmann, Amy G.;Mizrahi, Trina;Denberg, Thomas D.
临床惰性是血压（BP）控制不佳的主要原因。作者测试了针对医生、患者和办公室系统因素的干预措施在临床惰性和血压控制结局方面的有效性。共有591例血压升高的成人初级保健患者（平均收缩压=140 mm Hg或平均舒张压=90 mm Hg）被随机分配至干预或常规护理。外展协调员提高了患者和供应商对未达到的BP目标的认识，安排了以BP为重点的初级保健诊所就诊，并为供应商提供了治疗决策支持。干预降低了临床惰性（-29% vs-11%，P=.001）。尽管如此，干预和常规治疗之间的血压变化没有差异（收缩压和舒张压分别为-10.1/-4.1 mm Hg vs -9.1/-4.5 mm Hg，P= 0.50和0.71）。未来的主要关注的干预措施可能受益于使用特定的药物滴定协议，治疗依从性支持，更持久的患者随访。临床高血压杂志（格林威治）。2012; 14：322329. (c)2012年威利期刊公司
Clinical inertia is a major contributor to poor blood pressure (BP) control. The authors tested the effectiveness of an intervention targeting physician, patient, and office system factors with regard to outcomes of clinical inertia and BP control. A total of 591 adult primary care patients with elevated BP (mean systolic BP =140 mm Hg or mean diastolic BP =90 mm Hg) were randomized to intervention or usual care. An outreach coordinator raised patient and provider awareness of unmet BP goals, arranged BP-focused primary care clinic visits, and furnished providers with treatment decision support. The intervention reduced clinical inertia (-29% vs -11%, P=.001). Nonetheless, change in BP did not differ between intervention and usual care (-10.1/-4.1 mm Hg vs -9.1/-4.5 mm Hg, P=.50 and 0.71 for systolic and diastolic BP, respectively). Future primary carefocused interventions might benefit from the use of specific medication titration protocols, treatment adherence support, and more sustained patient follow-up visits. J Clin Hypertens (Greenwich). 2012; 14:322329. (c) 2012 Wiley Periodicals, Inc.