title: Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol.
abstract: BACKGROUND
  Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population.
  
  
  METHODS
  Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management.
  
  
  CONCLUSIONS
  The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings.
  
  
  BACKGROUND
  ClinicalTrials.gov.
  
  
  BACKGROUND
  NCT02069015. Registered February 19, 2014.
authors.affiliation: Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, 3939 Woodward Ave., 48201, Detroit, MI, USA. jgleason@med.wayne.edu.|Cardiovascular Research Institute, School of Medicine, Wayne State University, 421 E. Canfield St., 48201, Detroit, MI, USA. jgleason@med.wayne.edu.|Center for Urban Studies, Wayne State University, 5700 Cass Ave., 48202, Detroit, MI, USA. jgleason@med.wayne.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Gleason-Comstock
authors.affiliation: Center for Urban Studies, Wayne State University, 5700 Cass Ave., 48202, Detroit, MI, USA. astreater@wayne.edu.
authors.forename: Alicia
authors.initials: A
authors.lastname: Streater
authors.affiliation: Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, 3939 Woodward Ave., 48201, Detroit, MI, USA. jager@med.wayne.edu.
authors.forename: Joel
authors.initials: J
authors.lastname: Ager
authors.affiliation: Department of Economics, Wayne State University, 656 W. Kirby St., 2074 FAB, 48202, Detroit, MI, USA. allen.goodman@wayne.edu.
authors.forename: Allen
authors.initials: A
authors.lastname: Goodman
authors.affiliation: Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, UHC-6G, 48201, Detroit, MI, USA. ABrody@dmc.org.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brody
authors.affiliation: Center for Urban Studies, Wayne State University, 5700 Cass Ave., 48202, Detroit, MI, USA. fb8351@wayne.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Kivell
authors.affiliation: Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, 3939 Woodward Ave., 48201, Detroit, MI, USA. aparanjpe@med.wayne.edu.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Paranjpe
authors.affiliation: Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, 3939 Woodward Ave., 48201, Detroit, MI, USA. jvickers@med.wayne.edu.|Cardiovascular Research Institute, School of Medicine, Wayne State University, 421 E. Canfield St., 48201, Detroit, MI, USA. jvickers@med.wayne.edu.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Vickers
authors.affiliation: Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, UHC-6G, 48201, Detroit, MI, USA. lmmango@med.wayne.edu.
authors.forename: LynnMarie
authors.initials: L
authors.lastname: Mango
authors.affiliation: Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, UHC-6G, 48201, Detroit, MI, USA. rdawood@med.wayne.edu.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Dawood
authors.affiliation: Cardiovascular Research Institute, School of Medicine, Wayne State University, 421 E. Canfield St., 48201, Detroit, MI, USA. plevy@med.wayne.edu.|Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, UHC-6G, 48201, Detroit, MI, USA. plevy@med.wayne.edu.
authors.forename: Phillip
authors.initials: P
authors.lastname: Levy
mesh_terms: D000328:Adult; D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D009042:Motivation; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000458:organization & administration*; D012107:Research Design; D020377:Self Efficacy
chemical_list: D000959:Antihypertensive Agents