PATIENT-PHYSICIAN PARTNERSHIP TO IMPROVE HIGH BLOOD PRESSURE ADHERENCE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypertension is a common, chronic condition that contributes substantially to cardiovascular morbidity and mortality and resource use. Despite the proven efficacy of pharmacologic therapy and lifestyle modification for treatment of hypertension and prevention of its complications, most adults with established hypertension are uncontrolled. Limited access to medical care and financial barriers to obtaining medications play an important role; however, even among patients who receive regular care, blood pressure control remains suboptimal. Patient nonadherence to recommended therapies and problems in physician management of patients with hypertension are critical contributors to poor quality of care and negative health outcomes of hypertension. Of particular concern is the disproportionately high prevalence and incidence of hypertension and its complications among African Americans and socioeconomically disadvantaged persons. Ethnic and social class disparities in patient adherence are frequently based on financial, logistical, environmental, and cultural barriers that, while not unique to ethnic minorities and the poor, have a greater impact on these populations. We have designed patient and physician interventions that will address the specific needs of inner city ethnic minorities and persons living in poverty. The proposed study uses a patient-centered, culturally tailored, education and activation intervention with active follow-up delivered by a community health worker in the clinic. It also includes a computerized, self-study communication skills training program delivered via an interactive CD-ROM, with tailored feedback to address physicians' individual communication skills needs. Fifty physicians and 500 of their patients who have uncontrolled hypertension will be recruited into a randomized controlled trial with a 2X2 factorial design. The Patient-Physician Partnership (PPP) to Improve HBP Adherence Study will compare the relative effectiveness of the patient and physician interventions, separately, and in combination with one another, with the effectiveness the minimal interventions. The main hypothesis is that patients in the intervention groups will have better adherence to medication and lifestyle recommendations at 3 months and 12 months than patients in the minimal intervention. We will also assess other process and outcome measures (patient and physician ratings of quality of care, physicians' participatory decision-making (PDM) style, and satisfaction; the impact of training on patient-physician communication behaviors; and blood pressure control). This study will add to knowledge about the efficacy of culturally appropriate patient activation interventions and tailored physician communication training skills programs for improving adherence to hypertension therapy among inner city minorities and persons living in poverty. The 3 and 12 month patient assessments are beingconducted at the Johns Hopkins GCRC. Additionally, in an ancillary study to the above randomized controlled trial funded by NIH/NHLBI, we will assess the relation of behavioral, attitudinal, psychosocial and communication factors to CKD outcomes (awareness and perceived susceptibility to disease, adherence to prescribed therapies, progression, and development of co-morbid disease) in patients at high risk for CKD progression. the Patient-Physician Partnership Study currently uses GCRC services to obtain information on patients' physical examination, to administer questionnaires, and to obtain blood specimens. In the ancillary study, we will use data already collected in the parent study as well as data gathered from additional clinical measures (blood and urine specimens) to ascertain the relation between patient-physician communication, awareness of CKD, and patient attitudes, to the progression of CKD and CKD-related morbidity in this high-risk group of patients over a 9-month time period (3 month and 12 month assessments of the parent study).