Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial.
BACKGROUND
Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control.


METHODS
This was a 2-level (primary care provider and patient) cluster randomized trial with 2-year follow-up occurring among patients with hypertension enrolled from a Veterans Affairs Medical Center primary care clinic. Primary care providers (n = 17) in the intervention received computer-generated decision support designed to improve guideline concordant medical therapy at each visit; control providers (n = 15) received a reminder at each visit. Patients received usual care or a bimonthly tailored nurse-delivered behavioral telephone intervention to improve hypertension treatment. The primary outcome was proportion of patients who achieved a BP <140/90 mm Hg (<130/85 for diabetic patients) over the 24-month intervention.


RESULTS
Of the 816 eligible patients contacted, 190 refused and 38 were excluded. The 588 enrolled patients had a mean age of 63 years, 43% had adequate baseline BP control, and 482 (82%) completed the 24-month follow-up. There were no significant differences in amount of change in BP control in the 3 intervention groups as compared to the hypertension reminder control group. In secondary analyses, rates of BP control for all patients receiving the patient behavioral intervention (n = 294) improved from 40.1% to 54.4% at 24 months (P = .03); patients in the nonbehavioral intervention group improved from 38.2% to 43.9% (P = .38), but there was no between-group differences at the end of the study.


CONCLUSIONS
The brief behavioral intervention showed improved outcomes over time, but there were not significant between group differences.
Bosworth
Hayden B
HB
Center for Health Services Research in Primary Care, Durham VAMC, NC 27705, USA. hboswort@acpub.duke.edu
Olsen
Maren K
MK
Dudley
Tara
T
Orr
Melinda
M
Goldstein
Mary K
MK
Datta
Santanu K
SK
McCant
Felicia
F
Gentry
Pam
P
Simel
David L
DL
Oddone
Eugene Z
EZ
D001521:Behavior Therapy; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome