PATIENT-PHYSICIAN PARTNERSHIP TO IMPROVE HIGH BLOOD PRESSURE ADHERENCE

该子项目是利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 中心，不一定是研究者的机构。 高血压是一种常见的慢性疾病，可导致心血管疾病的发病率和死亡率以及资源消耗。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的疗效已得到证实，但大多数已确诊的高血压成人患者仍无法控制。获得医疗保健的机会有限，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，血压控制仍然不理想。患者对推荐治疗的不依从性和医生对高血压患者的管理问题是高血压护理质量差和不良健康结局的关键因素。特别令人关切的是，非裔美国人和社会经济处境不利者中高血压及其并发症的流行率和发病率过高。患者依从性的种族和社会阶层差异通常基于财务，后勤，环境和文化障碍，虽然不是少数民族和穷人所独有的，但对这些人群的影响更大。 我们设计了病人和医生的干预措施，以满足内城少数民族和生活在贫困中的人的具体需求。拟议的研究采用以患者为中心，文化定制，教育和激活干预，并由社区卫生工作者在诊所提供积极的后续行动。它还包括通过交互式CD-ROM提供的计算机化自学沟通技能培训计划，并提供定制反馈，以满足医生的个人沟通技能需求。将招募50名医生和500名患有未控制的高血压的患者参加一项2X2析因设计的随机对照试验。提高HBP依从性的患者-医生伙伴关系（PPP）研究将比较患者和医生干预的相对有效性，单独和相互结合，以及最小干预的有效性。主要假设是干预组的患者在3个月和12个月时比最小干预组的患者更好地遵守药物和生活方式建议。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，医生的参与决策（PDM）风格和满意度;培训对患者-医生沟通行为的影响;血压控制）。这项研究将增加对文化上适当的患者激活干预措施和定制的医生沟通技能培训计划的有效性的认识，以提高内城少数民族和贫困人口对高血压治疗的依从性。 3个月和12个月的患者评估在约翰霍普金斯GCRC进行。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CKD进展高风险患者的行为、态度、心理社会和沟通因素与CKD结局（对疾病的认识和感知易感性、对处方治疗的依从性、进展和共病的发生）的关系。病人-医生伙伴关系研究目前使用GCRC服务来获得关于病人体检的信息、管理问卷和获得血液样本。在辅助研究中，我们将使用母研究中已收集的数据以及从其他临床措施中收集的数据（血液和尿液标本），以确定患者与医生之间的沟通，对CKD的认识和患者态度之间的关系，在9个月的时间内，这一高危患者组的CKD进展和CKD相关发病率（母研究的3个月和12个月评估）。

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).