Improving Adherence to Blood Pressure Guidelines

描述(由申请者提供)：尽管在过去30年里制定了六套指南，但美国的血压(BP)控制很差。对指南的遵守不佳可能是由于跟踪和监测患者的系统不充分，以及医生对治疗的调整不充分。虽然存在各种策略来帮助医生提高指南的依从性和实现更好的血压控制，但还没有找到一致有效的方法来解决这个问题。首席研究员的长期目标是发展和评估医生和药剂师之间的合作关系，以改善药物治疗。这将是一项为期五年的多中心研究，旨在评估医生/药剂师协作团队在六个社区家庭实践站点对遵守高血压指南(JNC-VI)的影响。研究将分两个阶段进行。第一阶段包括需求评估，以确定遵守指南的障碍，并设计干预实施改进战略。第二阶段将是一项前瞻性随机试验，以评估医生/药剂师协作团队在遵守高血压指南和控制血压方面的影响。第一阶段的具体目标是：1)确定可能导致指南遵从性差的医生和患者变量的范围和性质；2)改进干预实施战略和设计工具，以评估指南的遵从性和遵守障碍。第二阶段的具体目标是：1)确定当医生参与医生/药剂师团队时，遵守指南的情况和对高血压的认识是否有变化；2)确定医生/药剂师团队是否可以实现比通常护理更好的血压控制。我们预计，通过这一干预措施改善指南的遵从性和降低血压，将对高血压患者产生重大影响。由于有超过3700万美国人患有无法控制的高血压，这一模式有可能成为帮助实现英国石油公司2010年健康人群目标的重要战略。

DESCRIPTION (provided by applicant): Blood pressure (BP) control in the U.S. is poor despite six sets of guidelines generated over the last 30 years. Poor adherence to guidelines may be due to inadequate systems to track and monitor patients and inadequate therapy adjustments by physicians. While various strategies exist to assist physicians with improving guideline adherence and achieving better BP control, a consistently effective approach to solving the problem has not been found. The long-range goal of the principal investigator is to develop and evaluate collaborative relationships between physicians and pharmacists that improve pharmaco-therapy. This will be a five-year, multi-center, study to evaluate the impact of physician/pharmacist collaborative teams on adherence to hypertension guidelines (JNC-VI) in six community-based family practice sites. There will be two study phases. Phase I comprises a needs assessment to identify barriers to guideline adherence and design intervention implementation refinement strategies. Phase II will be a prospective, randomized trial to assess the impact of physician/pharmacist collaborative teams on hypertension guideline adherence and BP control. The specific aims of Phase I are to: 1) identify the scope and nature of physician and patient variables that may contribute to poor guideline adherence and 2) to refine the intervention implementation strategy and design tools for assessing guideline adherence and barriers to adherence. The specific aims of Phase II are: 1) to determine if there is a change in guideline adherence and knowledge of hypertension when physicians are involved in physician/pharmacist teams and 2) to determine if physician/pharmacist teams can achieve better BP control compared to usual care. We expect that the improvement in guideline adherence and reduction in BP with this intervention will significantly impact patients with hypertension. Because there are more than 37 million Americans with uncontrolled hypertension, this model has to potential to become an important strategy to help achieve the BP goals for Healthy People 2010.