title: Effectiveness of a multidisciplinary intervention to improve hypertension control in an urban underserved practice.
abstract: Patient-centered, multidisciplinary interventions offer one of the most promising strategies to improve blood pressure (BP) control, yet effectiveness trials in underserved real-world settings are limited. We used a multidisciplinary strategy to improve hypertension control in an underserved urban practice. We collected 1007 surveys to monitor medication adherence and used weighted generalized estimating equations to examine trends in BP control. We examined 13,404 visits from patients with hypertension between August 2010 and February 2014. Overall, BP control rates increased from 51.0% to 67.4% (adjusted odds ratio, 1.58; 95% confidence interval, 1.44-1.74) by the end of the intervention phase and were maintained during the postintervention phase (adjusted odds ratio, 1.60; 95% confidence interval, 1.41-1.82). Medication adherence scores increased across the intervention (5.9-6.6; P < .001), but were not sustained at the conclusion of the study (5.9-6.2; P = .16). A multidisciplinary team approach involving registered nurses, pharmacists, and physicians resulted in substantial improvements in hypertension control in a real-world underserved setting.
authors.affiliation: Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Robert_Fortuna@urmc.rochester.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fortuna
authors.affiliation: Department of Pharmacy Practice & Administration, St. John Fisher College, Rochester, NY, USA.
authors.forename: Angela K
authors.initials: AK
authors.lastname: Nagel
authors.affiliation: Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Rose
authors.affiliation: Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: McCann
authors.affiliation: Department of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Teeters
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Denise D
authors.initials: DD
authors.lastname: Quigley
authors.affiliation: Department of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Bisognano
authors.affiliation: Greater Rochester Health Foundation, Rochester, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Legette-Sobers
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Cardiology, Canandaigua VA Medical Center, Canandaigua, NY, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Rocco
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015994:Incidence; D033183:Interdisciplinary Communication; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents
keywords: Effectiveness; multidisciplinary; nurse-managed protocols; pharmacist; underserved