Equitable Care for Hypertension: Blood Pressure and Patient-Reported Outcomes of the RICH LIFE Cluster Randomized Trial.

Autor:	Cooper LA; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; The Welch Center for Prevention, Epidemiology and Clinical Research (L.A.C., J.A.M., K.A.C., E.R.M., N.-Y.W., H.-C.Y.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Health, Behavior and Society (L.A.C., C.A.I.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Health Policy and Management (L.A.C., C.R.D.H., J.A.M., L.L.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Epidemiology (L.A.C., K.A.C., D.C.C., N.-Y.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Marsteller JA; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; The Welch Center for Prevention, Epidemiology and Clinical Research (L.A.C., J.A.M., K.A.C., E.R.M., N.-Y.W., H.-C.Y.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Health Policy and Management (L.A.C., C.R.D.H., J.A.M., L.L.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Carson KA; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; The Welch Center for Prevention, Epidemiology and Clinical Research (L.A.C., J.A.M., K.A.C., E.R.M., N.-Y.W., H.-C.Y.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Epidemiology (L.A.C., K.A.C., D.C.C., N.-Y.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Dietz KB; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.)., Boonyasai RT; Agency for Healthcare Research and Quality, Rockville, MD (R.T.B.)., Alvarez C; University of Pennsylvania School of Nursing, Philadelphia (C.A.)., Crews DC; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; Department of Epidemiology (L.A.C., K.A.C., D.C.C., N.-Y.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Dennison Himmelfarb CR; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; Department of Health Policy and Management (L.A.C., C.R.D.H., J.A.M., L.L.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Johns Hopkins School of Nursing, Baltimore, MD (C.R.D.H.)., Ibe CA; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; Department of Health, Behavior and Society (L.A.C., C.A.I.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Lubomski L; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; Department of Health Policy and Management (L.A.C., C.R.D.H., J.A.M., L.L.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Miller ER 3rd; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; 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Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.)., Hickman D; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; Sisters Together and Reaching, Inc, Baltimore, MD (D.H.)., Simmons M; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.)., Apfel Stein A; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.)., Yeh HC; Departments of Medicine (L.A.C., J.A.M., K.A.C., K.B.D., R.T.B., D.C.C., C.R.D.H., C.A.I., E.R.M., N.-Y.W., D.B., A.A.S., H.-C.Y.), Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD (L.A.C., J.A.M., K.A.C., K.B.D., C.A., D.C.C., C.R.D.H., C.A.I., L.L., E.R.M., D.B., D.H., M.S., A.A.S., H.-C.Y.).; The Welch Center for Prevention, Epidemiology and Clinical Research (L.A.C., J.A.M., K.A.C., E.R.M., N.-Y.W., H.-C.Y.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2024 Jul 16; Vol. 150 (3), pp. 230-242. Date of Electronic Publication: 2024 Jul 15.
DOI:	10.1161/CIRCULATIONAHA.124.069622
Abstrakt:	Background: Disparities in hypertension control are well documented but underaddressed. Methods: RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) was a 2-arm, cluster randomized trial comparing the effect on blood pressure (BP) control (systolic BP ≤140 mm Hg, diastolic BP ≤90 mm Hg), patient activation, and disparities in BP control of 2 multilevel interventions, standard of care plus (SCP) and collaborative care/stepped care (CC/SC). SCP included BP measurement standardization, audit and feedback, and equity-leadership training. CC/SC added roles to address social or medical needs. Primary outcomes were BP control and patient activation at 12 months. Generalized estimating equations and mixed-effects regression models with fixed effects of time, intervention, and their interaction compared change in outcomes at 12 months from baseline. Results: A total of 1820 adults with uncontrolled BP and ≥1 other risk factors enrolled in the study. Their mean age was 60.3 years, and baseline BP was 152.3/85.5 mm Hg; 59.4% were women; 57.4% were Black, 33.2% were White, and 9.4% were Hispanic; 74% had hyperlipidemia; and 45.1% had type 2 diabetes. CC/SC did not improve BP control rates more than SCP. Both groups achieved statistically and clinically significant BP control rates at 12 months (CC/SC: 57.3% [95% CI, 52.7%-62.0%]; SCP: 56.7% [95% CI, 51.9%-61.5%]). Pairwise comparisons between racial and ethnic groups showed overall no significant differences in BP control at 12 months. Patients with coronary heart disease showed greater achievement of BP control in CC/SC than in SCP (64.0% [95% CI, 54.1%-73.9%] versus 50.8% [95% CI, 42.6%-59.0%]; P =0.04), as did patients in rural areas (67.3% [95% CI, 49.8%-84.8%] versus 47.8% [95% CI, 32.4%-63.2%]; P =0.01). Individuals in both arms experienced statistically and clinically significant reductions in mean systolic BP (CC/SC: -13.8 mm Hg [95% CI, -15.2 to -12.5]; SCP: -14.6 mm Hg [95% CI, -15.9 to -13.2]) and diastolic BP (CC/SC: -6.9 mm Hg [95% CI, -7.8 to -6.1]; SCP: -5.5 mm Hg [95% CI, -6.4 to -4.6]) over time. The difference in diastolic BP reduction between CC/SC and SCP over time was statistically significant (-1.4 mm Hg [95% CI, -2.6 to -0.2). Patient activation did not differ between arms. CC/SC showed greater improvements in patient ratings of chronic illness care (Patient Assessment of Chronic Illness Care score) over 12 months (0.12 [95% CI, 0.02-0.22]). Conclusions: Adding a collaborative care team to enhanced standard of care did not improve BP control but did improve patient ratings of chronic illness care. Competing Interests: Dr Boonyasai’s contributions do not necessarily represent the views of the Department of Health and Human Services or the US government. Dr Crews has active research grants from Bayer and Somatus (paid to Johns Hopkins University). The other authors report no conflicts.
Databáze:	MEDLINE
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