J. Med. Internet Res. - Effects of a web-based patient activation intervention to overcome clinical inertia on blood pressure control: cluster randomized controlled trial.


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CKGROUND: Only approximately half of patients with hypertension have their blood pressure controlled, due in large part to the tendency of primary care providers (PCPs) not to intensify treatment when blood pressure values are elevated.OBJECTIVE: This study tested the effect of an intervention designed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment.METHODS: PCPs and their patients with hypertension (N=500) were recruited by letter and randomized into 2 study groups: (1) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control, and (2) control condition in which a similar tool suggested questions to ask about preventive services (eg, cancer screening). The Web-based tool was designed to be used during each of the 12 study months and before scheduled visits with PCPs. The primary outcome was the percentage of patients in both conditions with controlled blood pressure.RESULTS: Of 500 enrolled patients (intervention condition: n=282; control condition: n=218), 418 (83.6%) completed the 12-month follow-up visit. At baseline, 289 (61.5%) of participants had controlled blood pressure. Most (411/500, 82.2%) participants used the intervention during at least 6 of 12 months and 222 (62.5%) reported asking questions directly from the Web-based tool. There were no group differences in asking about medication intensification and there were no differences in blood pressure control after 12 months between the intervention condition (201/282, 71.3%) and control condition (143/218, 65.6%; P=.27) groups. More intervention condition participants discussed having a creatinine test (92, 52.6% vs 49, 35.5%; P=.02) and urine protein test (81, 44.8% vs 21, 14.6%; P<.001), but no group differences were observed in the rate of testing. The control condition participants reported more frequent discussions about tetanus and pneumonia vaccines and reported more tetanus (30, 13.8% vs 15, 5.3%; P=.02) and pneumonia (25, 11.5% vs 16, 5.7%; P=.02) vaccinations after 12 months.CONCLUSIONS: The use of an interactive website designed to overcome clinical inertia for hypertension care did not lead to improvements in blood pressure control. Participant adherence to the intervention was high. The control intervention led to positive changes in the use of preventive services (eg, tetanus immunization) and the intervention condition led to more discussions of hypertension-relevant tests (eg, serum creatinine and urine protein). By providing patients with individually tailored questions to ask during PCP visits, this study demonstrated that participants were likely to discuss the questions with PCPs. These discussions did not, however, lead to improvements in blood pressure control.TRIAL REGISTRATION: ClinicalTrials.gov NCT00377208; http://clinicaltrials.gov/ct2/show/NCT00377208 (Archived by WebCite at http://www.webcitation.org/6IqWiPLon).

Resumo Limpo

ckground approxim half patient hypertens blood pressur control due larg part tendenc primari care provid pcps intensifi treatment blood pressur valu elevatedobject studi test effect intervent design help patient ask question point care encourag pcps appropri intensifi blood pressur treatmentmethod pcps patient hypertens n recruit letter random studi group intervent condit patient use fulli autom websit month receiv tailor messag suggest question ask pcp improv blood pressur control control condit similar tool suggest question ask prevent servic eg cancer screen webbas tool design use studi month schedul visit pcps primari outcom percentag patient condit control blood pressureresult enrol patient intervent condit n control condit n complet month followup visit baselin particip control blood pressur particip use intervent least month report ask question direct webbas tool group differ ask medic intensif differ blood pressur control month intervent condit control condit p group intervent condit particip discuss creatinin test vs p urin protein test vs p group differ observ rate test control condit particip report frequent discuss tetanus pneumonia vaccin report tetanus vs p pneumonia vs p vaccin monthsconclus use interact websit design overcom clinic inertia hypertens care lead improv blood pressur control particip adher intervent high control intervent led posit chang use prevent servic eg tetanus immun intervent condit led discuss hypertensionrelev test eg serum creatinin urin protein provid patient individu tailor question ask pcp visit studi demonstr particip like discuss question pcps discuss howev lead improv blood pressur controltri registr clinicaltrialsgov nct httpclinicaltrialsgovctshownct archiv webcit httpwwwwebcitationorgiqwiplon

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