A Team Model of Hypertension Care in African Americans

非裔美国人高血压护理的团队模式

• 批准号: 7271974
• 负责人: BONNIE L SVARSTAD
• 金额: $ 34.83万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7271974
• 关键词: Adherence; Adverse effects; Adverse reactions; Affect; African American; American; Area; Behavior; Belief; Blood Pressure; Blood Pressure Monitors; Caring; Certification; Characteristics; Chicago; Chronic Kidney Failure; Clinic; Clinical Pharmacists; Collaborations; Communication; Communities; Community Pharmacy; Counseling; Diabetes Mellitus; Drug Costs; Educational process of instructing; Effectiveness of Interventions; End Point; Enrollment; Environment; Guidelines; Health Sciences; Health system; Healthcare Systems; Human Resources; Hypertension; Institutionalization; Intervention; Life Style; Measurement; Measures; Medical; Medical center; Modeling; Monitor; Organizational Change; Outcome; Patient Education; Patient Noncompliance; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy Education; Pharmacy facility; Physicians; Process; Provider; Psychological reinforcement; Randomized Controlled Trials; Rate; Recommendation; Reporting; Research Personnel; Role; Services; Site; Testing; Time; Training; Treatment Protocols; Treatment outcome; Veterans; Work; base; blood pressure regulation; compliance behavior; cost; cost effectiveness; design; improved; medication compliance; nondrug therapy; prescription document; prescription procedure; programs; skills; therapy design; tool

DESCRIPTION (provided by applicant): Despite efficacious drug and non-drug treatments, fewer than 50% of treated African American patients achieve adequate hypertension control (<140/90 mm Hg or <130/80 mm HG for patients with diabetes or chronic kidney disease). Studies suggest many reasons for lack of progress in this area, including patient non-adherence, suboptimal prescribing, and ineffective communication among patients, physicians, and pharmacists. This study will evaluate the cost-effectiveness of an organizational-level intervention in a randomized controlled trial involving 900 treated hypertensive African American patients in the Milwaukee and Chicago areas. The study will involve 36 community pharmacies (18 intervention vs.18 control) owned by a pharmacy corporation that operates over 2,000 pharmacies nationwide. The intervention will include: a) redefinition of pharmacist and pharmacy technician roles, b) implementation of a pharmacy-based "refill clinic" and tools for enhanced monitoring and collaboration with patients and physicians, and c) special training/certification of pharmacy personnel in blood pressure measurement, collaborative skills, and cultural competency. Hypertension control rates (primary endpoint) will be measured at- baseline, six months, and 12 months. Researchers will analyze the cost-effectiveness of the intervention, whether the recommended practices were implemented and continued over time, and ways in which the intervention affected the process of care (including pharmacist behavior, patient-reported barriers, prescribed regimens, and patient adherence). If the intervention is successful, researchers will implement and evaluate a dissemination plan for improving pharmacy-based care of hypertensive patients nationwide. The study is unique because it tests relatively simple and low cost interventions in the community pharmacy, an environment which is one of the most readily accessible components of the health care system.

描述(由申请人提供)： 尽管进行了有效的药物和非药物治疗，但只有不到50%的接受治疗的非洲裔美国人患者达到了适当的高血压控制(&lt；140/90 mm Hg或&lt；130/80 mm HG，对于糖尿病或慢性肾脏疾病患者)。研究表明，在这一领域缺乏进展的原因有很多，包括患者不遵守规定，处方不合理，患者、医生和药剂师之间的沟通不力。 这项研究将在一项随机对照试验中评估组织层面干预的成本效益，该试验涉及密尔沃基和芝加哥地区900名接受治疗的非裔美国人高血压患者。这项研究将涉及一家制药公司拥有的36家社区药店(18家干预与18家对照)，该公司在全国经营着2000多家药店。干预措施将包括：a)重新定义药剂师和药房技术员的角色；b)实施以药房为基础的“补充诊所”和工具，以加强与患者和医生的监测和合作；以及c)对药房人员进行血压测量、协作技能和文化能力方面的特别培训/认证。 高血压控制率(主要终点)将在基线、6个月和12个月时测量。研究人员将分析干预的成本效益，建议的做法是否随着时间的推移而实施和继续，以及干预影响护理过程的方式(包括药剂师行为、患者报告的障碍、处方方案和患者的依从性)。如果干预成功，研究人员将实施并评估一项传播计划，以改善全国范围内高血压患者的药房护理。这项研究是独一无二的，因为它在社区药房测试了相对简单和低成本的干预措施，社区药房是卫生保健系统中最容易获得的组成部分之一。