Supporting GPs and people with hypertension to maximise medication use to control blood pressure: a pilot cluster RCT of the MIAMI intervention.

Autor: Morrissey EC; School of Psychology, University of Galway, Galway, Ireland. eimear.morrissey@universityofgalway.ie., O'Grady L; School of Psychology, University of Galway, Galway, Ireland., Murphy PJ; Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland., Byrne M; School of Psychology, University of Galway, Galway, Ireland., Casey M; School of Medicine, University of Limerick, Limerick, Ireland., Doheny H; Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland., Dolan E; Connolly Hospital, Dublin 15, Blanchardstown, Ireland., Duane S; J.E Cairnes School of Business and Economics, University of Galway, Galway, Ireland.; Health Research Board Trials Methodology Research Network, University of Galway, Galway, Ireland., Durand H; Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland., Gillespie P; Health Economics and Policy Analysis Centre (HEPAC), CURAM, SFI Research Centre for Medical Devices (13/RC/2073_P2), Institute for Lifecourse & Society (ILAS), University of Galway, Galway, Ireland., Hayes P; Health Research Institute, University of Limerick, Limerick, Ireland., Hobbins A; Health Economics and Policy Analysis Centre (HEPAC), CURAM, SFI Research Centre for Medical Devices (13/RC/2073_P2), Institute for Lifecourse & Society (ILAS), University of Galway, Galway, Ireland., Hynes L; The West of Ireland Cardiac and Stroke Foundation, Croí, Galway, Ireland., McEvoy JW; National Institute for Prevention and Cardiovascular Health Ireland, Galway, Ireland.; School of Medicine, University of Galway, Galway, Ireland., Newell J; School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland., Bernieh D; Department of Cardiovascular Sciences, University of Leicester, Leicester, England., Gill H; Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester, Leicester, England., Gupta P; Department of Cardiovascular Sciences, University of Leicester, Leicester, England.; Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester, Leicester, England., Murphy AW; Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland., Molloy GJ; School of Psychology, University of Galway, Galway, Ireland.
Jazyk: angličtina
Zdroj: BMC primary care [BMC Prim Care] 2024 Nov 09; Vol. 25 (1), pp. 394. Date of Electronic Publication: 2024 Nov 09.
DOI: 10.1186/s12875-024-02635-7
Abstrakt: Background: Hypertension, or high blood pressure, is a key modifiable risk factor for heart disease and stroke. International guidelines have highlighted 'poor adherence to treatment' and 'physician inertia' as major barriers to effective blood pressure management. The Maximising Adherence, Minimising Inertia (MIAMI) intervention, a theory-based complex intervention, supports General Practitioners (GPs) and people with hypertension in maximising medication use to manage blood pressure. This pilot cluster randomised control trial (RCT) aimed to collect and analyse feasibility data to refine the MIAMI intervention and assess the feasibility of a definitive RCT.
Method: A pilot cluster RCT with a MIAMI intervention arm and usual care control arm was conducted. Quantitative data collection consisting of clinical measures and a self-report questionnaire took place at baseline and twelve week follow up. Semi-structured interviews with GP and patient participants were conducted. Fidelity (as measured by a protocol checklist and through qualitative interviews) and health economics costings were assessed.
Results: Six GP practices (intervention arm n = 3, control arm n = 3) and 52 patients (intervention arm n = 25, control arm n = 27) took part. All six GP practices and 92% of patients were retained. Fidelity, as measured by a checklist and through qualitative interviews, was good but three deviations from protocol were identified. Outcomes and measures used were acceptable. The implementation cost of the MIAMI intervention was estimated at €490 per participant. The qualitative data demonstrated that the intervention was considered acceptable and feasible by both GP and patient participants, except for the urine test component, which GPs found difficult to incorporate into practice due to logistical challenges.
Conclusions: The MIAMI intervention was considered largely acceptable and feasible. Some changes to both intervention components and trial processes are required but with these in place a definitive RCT could be considered worthwhile.
Trial Registration: ISRCTN registry, ISRCTN85009436, registered 17/1/23.
(© 2024. The Author(s).)
Databáze: MEDLINE
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