Improving Adherence to Blood Pressure Guidelines

描述（由申请人提供）：美国的血压（BP）控制很差，尽管在过去30年里产生了六套指南。对指南的不严格遵守可能是由于跟踪和监测患者的系统不完善以及医生的治疗调整不充分。虽然存在各种策略来帮助医生提高指南的依从性并实现更好的血压控制，但尚未找到一种一致有效的方法来解决问题。首席研究员的长期目标是发展和评估医师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、多中心的研究，旨在评估六个社区家庭诊所中医生/药剂师合作团队对高血压指南（JNC-VI）依从性的影响。研究将分为两个阶段。第一阶段包括需求评估，以确定遵循指南的障碍，并设计干预实施改进策略。II期将是一项前瞻性随机试验，以评估医师/药剂师合作团队对高血压指南依从性和血压控制的影响。第一阶段的具体目标是：1)确定可能导致指南依从性差的医生和患者变量的范围和性质；2)改进干预实施策略和设计评估指南依从性和依从性障碍的工具。第二阶段的具体目标是：1)确定当医生参与医师/药剂师团队时，指南依从性和高血压知识是否会发生变化；2)确定医师/药剂师团队与常规护理相比，是否可以实现更好的血压控制。我们期望这种干预对指南依从性的改善和血压的降低将显著影响高血压患者。因为有超过3700万美国人患有未控制的高血压，这种模式有可能成为帮助实现2010年健康人血压目标的重要策略。

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.