PATIENT-PHYSICIAN PARTNERSHIP TO IMPROVE HIGH BLOOD PRESSURE ADHERENCE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 高血压是一种常见的慢性疾病，在很大程度上导致心血管疾病的发病率、死亡率和资源使用。尽管药物治疗和生活方式改变在治疗高血压和预防其并发症方面已被证明是有效的，但大多数患有高血压的成年人仍未得到控制。获得医疗保健的机会有限和获得药物的经济障碍发挥了重要作用；然而，即使在接受定期护理的患者中，血压控制仍然不是最理想的。患者不遵守推荐的治疗方法和高血压患者的医生管理问题是导致高血压患者护理质量差和负面健康后果的关键因素。特别令人关切的是，非裔美国人和社会经济弱势群体中高血压及其并发症的患病率和发病率高得不成比例。患者依从性方面的种族和社会阶层差异往往基于经济、后勤、环境和文化障碍，虽然这些障碍并不是少数族裔和穷人独有的，但对这些人群有更大的影响。我们设计了病人和医生干预措施，以满足市中心少数民族和生活贫困的人的特殊需要。这项拟议的研究使用了以患者为中心、根据文化定制的教育和激活干预措施，并由诊所的社区卫生工作者提供积极的随访。它还包括通过交互式CD-ROM提供的计算机化的自学沟通技能培训计划，以及针对医生个人沟通技能需求的量身定做的反馈。50名医生和他们的500名高血压患者将被招募到一项2X2析因设计的随机对照试验中。患者-医生伙伴关系(PPP)改善高血压依从性研究将分别比较患者和医生干预措施的相对有效性，以及相互结合的干预措施与最低限度干预措施的有效性。主要假设是，与最小干预组的患者相比，干预组患者在3个月和12个月时对药物和生活方式建议的依从性更好。我们还将评估其他过程和结果指标(患者和医生对护理质量的评分、医生的参与式决策(PDM)风格和满意度；培训对患者-医生沟通行为的影响；以及血压控制)。这项研究将增加关于文化上适当的患者激活干预措施和量身定做的医生沟通培训技能计划的有效性的知识，以提高市中心少数民族和贫困人口对高血压治疗的依从性。 约翰霍普金斯大学GCRC正在进行为期3个月和12个月的患者评估。此外，在由NIH/NHLBI资助的上述随机对照试验的辅助研究中，我们将评估行为、态度、心理社会和沟通因素与CKD进展的高风险患者的CKD结局(意识和感知疾病易感性、坚持处方疗法、进展和发展)的关系。患者-医生伙伴关系研究目前使用GCRC服务来获取有关患者体检的信息、管理问卷和获取血液样本。在辅助研究中，我们将使用在母研究中收集的数据以及从其他临床测量(血液和尿液样本)中收集的数据来确定在9个月的时间段(对母研究的3个月和12个月的评估)中，患者与医生之间的沟通、对慢性肾脏病的认识和患者态度与慢性肾脏病和慢性肾脏病相关发病率的进展之间的关系。

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).