title: A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients.
abstract: BACKGROUND
  African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations.
  
  
  OBJECTIVE
  To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups.
  
  
  METHODS
  Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland.
  
  
  METHODS
  Forty-one primary care physicians and 279 hypertension patients.
  
  
  METHODS
  Physician communication skills training and patient coaching by community health workers.
  
  
  METHODS
  Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control.
  
  
  RESULTS
  Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p = 0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β = +6.20 vs. -5.24, p = 0.03) and PIC dimensions related to doctor facilitation (β = +0.22 vs. -0.17, p = 0.03) and information exchange (β = +0.32 vs. -0.22, p = 0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg).
  
  
  CONCLUSIONS
  Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.
authors: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA. lisa.cooper@jhmi.edu
authors: Lisa A
authors: LA
authors: Cooper
authors: Debra L
authors: DL
authors: Roter
authors: Kathryn A
authors: KA
authors: Carson
authors: Lee R
authors: LR
authors: Bone
authors: Susan M
authors: SM
authors: Larson
authors: Edgar R
authors: ER
authors: Miller
authors: Michael S
authors: MS
authors: Barr
authors: David M
authors: DM
authors: Levine
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003142:Communication; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008507:Medically Underserved Area; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data*; D012923:Social Class; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents