title: Brief provider communication skills training fails to impact patient hypertension outcomes.
abstract: OBJECTIVE
  Hypertension remains a prevalent risk factor for cardiovascular disease, and improved medication adherence leads to better blood pressure (BP) control. We sought to improve medication adherence and hypertension outcomes among patients with uncontrolled BP through communication skills training targeting providers.
  
  
  METHODS
  We conducted a randomized controlled trial to assess the effects of a communication skills intervention for primary care doctors compared to usual care controls, on the outcomes of BP (systolic, diastolic), patient self-reported medication adherence, and provider counseling, assessed at baseline and post-intervention. We enrolled 379 patients with uncontrolled BP; 203 (54%) with follow-up data comprised our final sample. We performed random effects least squares regression analyses to examine whether the provider training improved outcomes, using clinics as the unit of randomization.
  
  
  RESULTS
  In neither unadjusted nor multivariate analyses were significant differences in change detected from baseline to follow-up in provider counseling, medication adherence or BP, for the intervention versus control groups.
  
  
  CONCLUSIONS
  The intervention did not improve the outcomes; it may have been too brief and lacked sufficient practice level changes to impact counseling, adherence or BP.
  
  
  CONCLUSIONS
  Future intervention efforts may require more extensive provider training, along with broader systematic changes, to improve patient outcomes.
authors.affiliation: Hunter College, City University of New York (CUNY) School of Public Health, New York, USA. Electronic address: meredith.manze@hunter.cuny.edu.
authors.forename: Meredith G
authors.initials: MG
authors.lastname: Manze
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford VAMC, Bedford, USA.
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Orner
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford VAMC, Bedford, USA; Health Policy and Management Department, Boston University School of Public Health, Boston, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Glickman
authors.affiliation: University of Massachusetts Medical School, Worcester, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford VAMC, Bedford, USA; Health Policy and Management Department, Boston University School of Public Health, Boston, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
authors.affiliation: VA Boston Healthcare System, Boston, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, USA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003142:Communication; D003376:Counseling / Q000193:education*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D018802:Patient-Centered Care / Q000379:methods* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure; Hypertension; Medication adherence; Patient-centered care; Patient-provider communication