A multimodal blood pressure control intervention in 3 healthcare systems.
| Autor: | Magid DJ; Institute for Health Research, Kaiser Permanente Colorado, Denver, USA. david.j.magid@kp.org, Ho PM, Olson KL, Brand DW, Welch LK, Snow KE, Lambert-Kerzner AC, Plomondon ME, Havranek EP |
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| Jazyk: | angličtina |
| Zdroj: | The American journal of managed care [Am J Manag Care] 2011 Apr; Vol. 17 (4), pp. e96-103. |
| Abstrakt: | Objective: To determine if a multimodal intervention composed of patient education, home blood pressure (BP) monitoring, BP measurement reporting to an interactive voice response (IVR) phone system, and clinical pharmacist follow-up improves BP control compared with usual care. Study Design: Prospective study with patient enrollment, medication consultation and adjustment, remote BP monitoring, and follow-up at 6 months. Methods: This randomized controlled trial was conducted at 3 healthcare systems in Denver, Colorado, including a large health maintenance organization, a Veterans Affairs medical center, and a county hospital. At each site, patients with uncontrolled BP were randomized to the multimodal intervention vs usual care for 6 months, with the primary end point of BP reduction. Results: Of 338 patients randomized, 283 (84%) completed the study, including 138 intervention patients and 145 usual care patients. Baseline BP was higher in the intervention group vs the usual care group (150.5/89.4 vs 143.8/85.3 mm Hg). At 6 months, BPs were similar in the intervention group vs the usual care group (137.4 vs 136.7 mm Hg, P = .85 for systolic; 82.9 vs 81.1 mm Hg, P = .14 for diastolic). However, BP reductions were greater in the intervention group vs the usual care group (−13.1 vs −7.1 mm Hg, P = .006 for systolic; −6.5 vs −4.2 mm Hg, P = .07 for diastolic). Adherence to medications was similar between the 2 groups, but intervention patients had a greater increase in medication regimen intensity. Conclusions: A multimodal intervention of patient education, home BP monitoring, BP measurement reporting to an IVR system, and clinical pharmacist follow-up achieved greater reductions in BP compared with usual care. |
| Databáze: | MEDLINE |
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