Race/ethnic differences in guideline recommended hypertension medications in VHA

VHA 指南推荐高血压药物的种族/民族差异

• 批准号: 10186551
• 负责人: April F Mohanty
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186551
• 关键词: Address; Adult; Age; Algorithms; Black race; Blood Pressure; Body mass index; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Cities; Clinical Trials; Confidence Intervals; Consolidated Framework for Implementation Research; Data; Development; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Ensure; Epidemiologist; Ethnic Origin; Event; Fellowship; Female; Foundations; Future; Goals; Guidelines; Health Services; Health Services Administration; Health Services Research; Healthcare; Healthcare Systems; Heart; Heart failure; Hispanics; Historically Black Colleges and Universities; Hypertension; Incidence; Inequality; Informatics; Intervention; Intervention Trial; Interview; Joints; Lead; Life; Medical Informatics; Medical center; Methods; Minority; Minority Groups; Modeling; Myocardial Infarction; Natural Language Processing; Outcome; Patients; Pharmaceutical Preparations; Plant Roots; Population; Practice Management; Prevalence; Provider; Publishing; Race; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Retrospective cohort study; Risk Factors; Safety; Scientist; Services; Site; Sodium Chloride; Stroke; Telephone Interviews; Testing; Time; Training; Training Programs; Treatment Protocols; Treatment outcome; United States; United States Department of Veterans Affairs; United States National Institutes of Health; Veterans; Veterans Health Administration; active duty; acute coronary syndrome; base; blood pressure intervention; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; career; ethnic difference; ethnic minority population; evidence base; follow-up; hazard; health disparity; health inequalities; high risk; hypertension control; hypertension treatment; improved; interest; male; military veteran; minority scientist; mortality; patient oriented; racial and ethnic; racial difference; racial disparity; racial minority; satisfaction; sex; tool; usability

Among Veterans, hypertension is the most common chronic condition with a prevalence of 37% and can lead to stroke, myocardial infarction, chronic kidney disease, and heart failure. Among blacks, hypertension occurs earlier in life, is more prevalent and severe, and is less likely to be controlled. While control of hypertension has significantly improved over recent years in the Veterans Affairs (VA), from 46% in 2000 to 76% in 2010, disparities persist among blacks, and reasons are not well understood. The Joint National Committee (JNC) publishes guidelines on evidence-based medications for hypertension treatment. However, controversy remains regarding the target blood pressure (BP) to achieve with therapy. The recently published Systolic Blood Pressure Intervention Trial (SPRINT), a landmark clinical trial, is anticipated to lead to changes in hypertension practices for patients with increased cardiovascular disease risk and without a history of diabetes. Investigators reported a reduction of systolic BP to <120 mm Hg (vs < 140 mm Hg) was associated with a lower incidence of cardiovascular-events, - mortality, and all-cause mortality for both black and nonblack patients. The extent to which systolic BP control of <120 mm Hg is achieved in VA is unknown. Special focus is needed for the VA group at highest risk for uncontrolled BP, black Veterans. This group is expected to grow at least 3% from 11% of Veterans in 2014 to 14% by 2034. The goals of this project are: Aim 1. To examine, one year following Veterans’ incident hypertension diagnosis, patient level predictors of (1) use of guideline-recommended medications and (2) BP control among Veterans and to describe how the effect of these predictors varies by race; Aim 2. To identify provider and facility level predictors of use of guideline-recommended medications and BP control among Veterans with incident hypertension and to describe how the effect of these predictors varies by race using mixed-methods; and Aim 3. To develop and pilot test a provider/team focused informatics strategy to facilitate hypertension control with enhanced features for racial minority Veterans. Aims 1-2 involve a longitudinal retrospective cohort study of black and white Veterans from VA facilities nationwide with incident hypertension 2007-2012 and examining outcomes of (1) prescriptions for JNC7 guideline-recommended medications and (2) controlled hypertension 1-year after incident hypertension diagnosis. Using regression models, patient- (Aim 1), provider- and facility-level (Aim 2) variables will be identified that are predictors for not receiving of guideline-recommended medications for hypertension and/or lack of BP control at 1-year of follow-up. Aims 1-2 further examine how these predictors vary by race. The qualitative analysis for Aim 2 will include chart review using natural language processing methods and a total of 36 telephone interviews with Patient Aligned Care Team (PACT) providers from 4 VA facilities (identified from Aim 1 and Aim 2) to ascertain reasons for not prescribing guideline-recommended hypertension medications among patients identified from Aims 1-2.The Consolidated Framework of Implementation Research will be used to conduct these interviews. Aim 3 includes the development of a trained and tested algorithm (from retrospective data) that incorporates SPRINT and Aim 1-2 findings and enhanced features for racial minorities based. A scenario based mockup with 20 Salt Lake City VA Medical Center (SLCVAMC) PACT providers will be used to determine initial tool feasibility, usability, acceptance, provider interest, safety, and satisfaction.

在退伍军人中，高血压是最常见的慢性病，患病率为37%