[Shared decision-making with hypertensive patients. Results of an implementation in Germany].
OBJECTIVE
Lack of compliance is a common problem in the treatment of hypertension. Ineffective physician-patient-communication and a lack of patients involvement can play a crucial role. We tested the hypothesis that shared decision-making (SDM) results in higher involvement of patients in their blood pressure lowering therapy and evaluated the effects of SDM on the control of blood pressure.


METHODS
Two groups of 84 hypertensives were compared: an intervention group (26 women and 13 men, age 61 +/- 10 years) treated by 15 specially SDM-trained primary care physicians, and a control group of 45 hypertensives. All 84 patients were enrolled in a patient education programme. Changes of blood pressure were assessed after one year by self-measurements. Questionnaires about their attitude to patient autonomy, the SDM process, quality of life, physician-patient-relationship and life-style changes were analysed as well.


RESULTS
After one year the blood pressure had decreased in both the intervention group (-9.26 +/- 10.2/-5.3 +/- 9.5 mmHg, p < 0.001) and in the control group (-6.0 +/- 11.8/-3.0 +/- 8.3 mmHg, p < 0.05), without a significant difference between the two groups. Among a subgroup of patients with a marked preference for SDM there was a close correlation between an increase of SDM and a decrease in systolic blood pressure (p = 0.016). Also, the numbers of antihypertensive drugs increased more in the intervention group (p = 0.022) than in control patients. Furthermore, increase in knowledge about hypertension and its treatment was greater in the intervention group (P=0.006).


CONCLUSIONS
Implementation of SDM had a significant effect on systolic blood pressure control only in the subgroup of patients with marked preference for SDM. Thus, the identification of patients with a preference for SDM may improve blood pressure control and their adherence to the prescribed drug therapy.
Deinzer
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Institut für Präventive Medizin der Nieren-, Hochdruck- und Herzerkrankungen an der Universität Erlangen-Nürnberg, Erlangen.
Babel
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Veelken
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Kohnen
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Schmieder
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D000328:Adult; D001294:Attitude to Health; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D003142:Communication; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010358:Patient Participation / Q000523:psychology; D017060:Patient Satisfaction; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome