Hypertension Control & Therapy Adherence

描述(申请人提供)：为了提高患者对处方降压药物、血压控制和医患沟通的依从性，并减少每个患者的种族差异，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，服务于许多贫穷的非裔美国人和白人患者。我们将通过教授临床医生使用以患者为中心的咨询来实施行之有效的干预策略，提高已知有助于患者改变健康相关行为的技能，并提高临床医生的文化能力，从而进一步改善临床医生与患者的沟通。在一组临床医生中，我们将只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，并以既定的文化能力培训方法加以补充，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片顶端监测的使用情况、临床医生提供的关于抗高血压药物的建议和咨询以及文化能力技能的使用情况，以及血压可控患者的比例来评估干预前患者对处方药的依从性。在干预之后，我们将重新评估每一个结果。我们的具体目标是：1)提高患者对处方降压治疗的依从性；1.检查基线的遵从率，并检查遵守情况是否存在种族差异，1b。从基线到后续评估减少患者对抗高血压治疗依从性的种族差异；评估以患者为中心的咨询干预与以患者为中心的咨询加上文化能力培训对患者服药依从性的相对效果；2)增加控制高血压患者的比例；2a。检查控制性高血压患者的基线比例，以及控制率是否存在种族差异；减少从基线到后续评估的控制性高血压患者比例的种族差异；评估以患者为中心的咨询相对于以患者为中心的咨询的相对有效性，并通过文化能力培训加强对患者的血压控制；3)改善临床医生与患者在用药方面的沟通，通过临床医生提供关于抗高血压药物的建议和咨询的频率增加以及使用具有文化能力的沟通方式来衡量；检查临床医生在提供建议和咨询方面是否存在种族差异，或者在基线水平上关于抗高血压药物的文化沟通模式是否存在种族差异；检查建议的干预措施是否随着时间的推移减少了临床医生交流中观察到的任何种族差异；评估以患者为中心的咨询干预与以患者为中心的咨询加上文化能力培训对临床医生沟通模式的相对有效性。

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.