Improving Adherence to Blood Pressure Guidelines

描述（由申请人提供）：尽管在过去30年中制定了六套指南，但美国的血压（BP）控制仍然很差。 对指南的依从性差可能是由于跟踪和监测患者的系统不足以及医生的治疗调整不足。 虽然存在各种策略，以帮助医生提高指南的遵守和实现更好的血压控制，一个一贯有效的方法来解决这个问题还没有找到。长期的目标，主要研究者是开发和评估医生和药剂师之间的合作关系，提高药物治疗。 这将是一项为期五年的多中心研究，旨在评估医生/药剂师合作团队对六个社区家庭医疗中心高血压指南（JNC-VI）依从性的影响。 将有两个研究阶段。 第一阶段包括需求评估，以确定遵守准则的障碍，并设计干预措施的实施改进战略。 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）完善干预实施策略，设计评估指南依从性和依从性障碍的工具。 II期的具体目的是：1）确定当医生参与医生/药剂师团队时，指南依从性和高血压知识是否发生变化; 2）确定与常规护理相比，医生/药剂师团队是否可以实现更好的血压控制。 我们预计，改善指南的遵守和降低血压与这种干预将显着影响高血压患者。 由于有超过3700万美国人患有不受控制的高血压，该模型有可能成为帮助实现BP 2010年健康人群目标的重要策略。

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.