Hypertension Control & Therapy Adherence

高血压控制

• 批准号: 6725047
• 负责人: Nancy R. Kressin
• 金额: $ 80.72万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 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 2008-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6725047
• 关键词: African American; antihypertensive agents; behavioral /social science research tag; cardiovascular disorder chemotherapy; cardiovascular disorder education; cardiovascular disorder prevention; caucasian American; clinical research; counseling; culture; education evaluation /planning; health care personnel education; health care service evaluation; health disparity; health services research tag; human subject; hypertension; low socioeconomic status; outcomes research; patient care personnel relations; patient oriented research; racial /ethnic difference; therapy compliance

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）：为了改善患者的依从性，使用处方的抗高血压药物，血压控制和医生沟通，并减少每种药物的种族差异，我们建议在一家大型城市教学医院的一般内科医学诊所中进行三臂随机对照试验，该试验为许多贫穷的非裔美国人和白人患者服务。我们将通过教授临床医生使用以患者为中心的咨询，增强已知的技能来实施验证的干预策略，这些技能可以帮助患者改变与健康相关的行为，并增强临床医生的文化能力，从而进一步改善临床医生的交流。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，在第二盘中，我们将实施以患者为中心的咨询教育计划，通过既定的文化能力培训方法来增强它，而第三组（对照组）将提供常规的护理。为了评估结果，我们将首先通过患者自我报告和使用电子药丸顶部监测，临床医生提供有关抗高血压药物的建议和咨询咨询，以及对抗高血压药物的使用以及使用受控血压的患者的比例。在干预措施之后，我们将重新评估这些结果中的每一个。我们的具体目的是：1）改善患者对处方抗高血压疗法的遵守； 1a。检查基线时的依从率，并检查依从性是否存在种族差异，1B。从基线到后续评估，通过抗高血压疗法的患者依从性降低种族差异； 1C。与以患者为中心的咨询相比，评估以患者为中心的咨询咨询的相对疗效，该咨询通过对患者药物依从性的文化能力培训增强； 2）增加受控高血压患者的比例； 2a。检查受控高血压患者的基线比例，以及控制率是否存在种族差异； 2b。从基线到随访评估的高血压患者比例的种族差异降低； 2C。与以患者为中心的咨询相比，评估以患者为中心的咨询的相对疗效，通过对患者血压控制的文化能力培训增加了以患者为中心的咨询； 3）改善临床医生与患者在使用药物使用方面的沟通，这是通过增加临床医生提供抗高血压药物的建议和咨询的频率来衡量的，并使用具有文化胜任的沟通方式； 3a。检查临床医生提供有关基线抗高血压药物的建议和咨询或具有文化胜任的沟通模式的种族差异； 3b。检查所提出的干预措施是否会随着时间的流逝而降低临床医生交流中观察到的任何种族差异； 3C。与以患者为中心的咨询相比，评估以患者为中心的咨询干预的相对疗效，以通过临床医生的沟通方式进行文化能力培训增强。