Hypertension Control & Therapy Adherence

高血压控制

• 批准号: 7226326
• 负责人: Nancy R. Kressin
• 金额: $ 47.98万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-01 至 2010-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7226326
• 关键词: Adherence; Affect; African American; American; Antihypertensive Agents; Association of American Medical Colleges; Behavior; Caring; Clinic; Communication; Competence; Control Groups; Counseling; Education; Educational Curriculum; Educational process of instructing; Electronics; Failure; Fostering; Frequencies; Healthcare; Hypertension; Institute of Medicine (U.S.); Internal Medicine; Intervention; Joints; Lead; Measures; Methods; Monitor; Numbers; Outcome; Patient Self-Report; Patients; Pattern; Pharmaceutical Preparations; Principal Investigator; Race; Randomized; Randomized Controlled Trials; Rate; Relative (related person); Reporting; Research; Risk; Site; Teaching Hospitals; Thinking; Time; Training; Upper arm; Variant; base; blood pressure regulation; compliance behavior; ethnic minority population; follow-up; improved; medication compliance; metropolitan; patient oriented; pill; programs; racial difference; skills; therapy adherence

DESCRIPTION (provided by applicant): To improve patients' adherence with prescribed anti-hypertensive medication, blood pressure control and doctor-patient communication, and to decrease racial disparities in each, we propose a three-armed randomized controlled trial in the general internal medicine clinics of a large urban teaching hospital serving many poor African American and white patients. We will implement proven intervention strategies by teaching clinicians to use patient-centered counseling, enhancing skills that are known to help patients change health-related behaviors, and to enhance clinicians' cultural competency and thereby further improve clinician-patient communication. In one set of clinicians we will implement only the patient-centered counseling program, in a second set we will implement the patient-centered counseling education program, augmenting it with an established method for cultural competency training, and a third set (control group) will provide usual care. To assess outcomes, we will first assess the pre-intervention patient adherence to prescribed medications through patient self-report and the use of electronic pill top monitoring, clinicians' provision of advice and counseling about anti-hypertensive medications and use of cultural competency skills, and the proportion of patients with controlled blood pressure. Subsequent to the interventions, we will reassess each of these outcomes. Our specific aims are to: 1) Improve patients' adherence to prescribed anti-hypertensive therapy; 1a. Examine adherence rates at baseline, and examine whether there are racial differences in adherence, 1b. Decrease racial disparities in patient adherence with anti-hypertensive therapy from the baseline to the follow-up assessments; 1c. Evaluate the relative efficacy of the patient-centered counseling intervention compared to patient-centered counseling augmented by cultural competency training on patients' medication adherence; 2) Increase the proportion of patients with controlled hypertension; 2a. Examine the baseline proportion of patients with controlled hypertension, and whether there are racial differences in rates of control; 2b. Decrease racial disparities in the proportion of patients with controlled hypertension from the baseline to the follow-up assessments; 2c. Evaluate the relative efficacy of patient-centered counseling compared to patient-centered counseling augmented by cultural competency training on patients' blood pressure control; 3) Improve clinicians' communication with patients regarding medication use, as measured by increased frequency of clinicians' provision of advice and counseling about anti-hypertensive medications and use of culturally competent communication styles; 3a. Examine whether there are racial disparities in clinicians' provision of advice and counseling or culturally competent communication patterns about anti-hypertensive medications at baseline; 3b. Examine whether the proposed interventions decrease any observed racial disparities in clinician communication over time; 3c. Evaluate the relative efficacy of the patient-centered counseling intervention compared to patient-centered counseling augmented by cultural competency training on clinicians' communication patterns.

描述（由申请人提供）：为了提高患者对处方抗高血压药物、血压控制和医患沟通的依从性，并减少各个方面的种族差异，我们建议在一家大型城市教学医院的普通内科诊所进行三组随机对照试验，为许多贫困的非裔美国人和白人患者提供服务。我们将通过教导临床医生使用以患者为中心的咨询、增强已知可帮助患者改变健康相关行为的技能以及增强临床医生的文化能力，从而进一步改善临床医患沟通来实施行之有效的干预策略。在一组临床医生中，我们将仅实施以患者为中心的咨询计划，在第二组中，我们将实施以患者为中心的咨询教育计划，并通过既定的文化能力培训方法对其进行增强，第三组（对照组）将提供常规护理。为了评估结果，我们将首先通过患者自我报告和电子药顶监测的使用、临床医生提供的有关抗高血压药物的建议和咨询以及文化能力技能的使用，以及血压得到控制的患者比例来评估干预前患者对处方药物的依从性。干预措施结束后，我们将重新评估每项结果。我们的具体目标是： 1）提高患者对处方抗高血压治疗的依从性； 1a.检查基线的依从率，并检查依从性是否存在种族差异，1b。从基线到后续评估，减少患者抗高血压治疗依从性的种族差异； 1c.评估以患者为中心的咨询干预与通过文化能力培训增强的以患者为中心的咨询对患者用药依从性的相对疗效； 2）提高高血压得到控制的患者比例； 2a.检查高血压控制率患者的基线比例，以及控制率是否存在种族差异； 2b.从基线到随访评估，减少高血压得到控制的患者比例的种族差异； 2c.评估以患者为中心的咨询与通过文化能力培训增强的以患者为中心的咨询对患者血压控制的相对功效； 3) 改善临床医生与患者有关药物使用的沟通，衡量标准是临床医生提供有关抗高血压药物的建议和咨询的频率增加，以及使用文化上合适的沟通方式； 3a.检查基线时临床医生提供的建议和咨询是否存在种族差异，或者关于抗高血压药物的文化沟通模式是否存在差异； 3b.检查拟议的干预措施是否会随着时间的推移减少临床医生沟通中观察到的种族差异； 3c.评估以患者为中心的咨询干预与通过临床医生沟通模式的文化能力培训增强的以患者为中心的咨询相比的相对功效。

项目成果

Effects of daily adherence to antihypertensive medication on blood pressure control.

• DOI: 10.1111/j.1751-7176.2011.00427.x
• 发表时间: 2011-06
• 期刊: Journal of clinical hypertension (Greenwich, Conn.)
• 作者: Rose AJ;Glickman ME;D'Amore MM;Orner MB;Berlowitz D;Kressin NR
• 通讯作者: Kressin NR

Intensifying therapy for hypertension despite suboptimal adherence.

• DOI: 10.1161/hypertensionaha.109.133389
• 发表时间: 2009-09
• 期刊: Hypertension (Dallas, Tex. : 1979)
• 作者: Rose AJ;Berlowitz DR;Manze M;Orner MB;Kressin NR
• 通讯作者: Kressin NR