A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study

Bonds, Denise E.; Hogan, Patricia E.; Bertoni, Alain G.; Chen, Haiying; Clinch, C. Randall; Hiott, Ann E.; Rosenberger, Erica L.; Goff, David C.

doi:10.1016/j.ahj.2008.09.021

Cited by 24 publications

(23 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Examples of effective strategies include home BP monitoring; in-person, telephone, or web-based motivational strategies delivered by a nurse and/ or a pharmacist; collaborative management by primary carepharmacist teams; 60,61 and involvement of community health workers as members of the care team. 62 Physician-directed interventions such as continuing medical education, academic detailing, quality review and feedback, and computer decision support/reminders to change prescribing behaviors, when used alone, have not shown improvements in health outcomes, [63][64][65][66][67][68] and few studies have focused on communication skills training skills for providers. 39,61 If shown to be effective in well-designed studies, integrating the best of these strategies will provide models that may be disseminated into practice to improve quality of care and reduce disparities in cardiovascular disease outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

View full text Add to dashboard Cite

BACKGROUND: Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJECTIVE:To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." DESIGN, SETTINGS, AND PATIENTS:Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. MEASUREMENTS:Communication behaviors and visit length from coding of audiotapes. RESULTS:After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B=−3.9 min, p<0.01) with less biomedical (B=−24.0, p=0.05), psychosocial (B=−19.4, p< 0.01), and rapport-building (B=−19.5, p=0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP.CONCLUSIONS: This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

View full text Add to dashboard Cite

show abstract

“…[10;11] However, the implementation of the intervention proved to be a challenge for several reasons. Provider turnover, technical issues with Palms requiring staff assistance, technology differences among practices, provider and practice schedules, and differences in provider familiarity with technology all proved to be challenges for which we had not originally planned.…”

Section: Discussionmentioning

confidence: 99%

Implementing a palm pilot intervention for primary care providers: Lessons learned

Rosenberger

Goff

Blackwell

et al. 2009

Contemporary Clinical Trials

Self Cite

View full text Add to dashboard Cite

The Personal Digital Assistance for Guideline Adherence (GLAD Heart) study was designed to test a strategy to improve quality of care through increased adherence to ATPIII cholesterol guidelines. This paper describes the overall study design including the multi-faceted intervention and outcome measures. Sixty-one primary care practices in NC were recruited and randomized to either a personal digital assistant-based cholesterol management intervention or an intervention similar in intensity and frequency of contact but focused on a hypertension clinical practice guideline. Installation and implementation of the technology intervention was challenging. Over the course of the study, there were 74 technical issues requiring assistance for the palm pilot from 23 participating practices. The GLAD Heart project was completed successfully with some impact on cholesterol management. Technology has the potential to improve the quality of care provided in the healthcare setting. However, potentially expensive interventions such as that conducted in GLAD Heart should undergo rigorous testing to assure their efficacy before widespread adoption.

show abstract

“…I did a quick update of this review for the period 2004–2009 and found 16 randomized controlled trials; 6 of these targeted clinicians only, 3 targeted both clinicians and patients, and 7 targeted patients only. Studies that targeted clinicians only included continuing medical education, academic detailing, quality review and feedback, and computer decision support/reminders to change prescribing behaviors; none showed improvements in patient adherence or blood pressure control 111–116 Table 2. shows the 10 studies that included patient interventions 117–126.…”

Section: Questions and Discussionmentioning

confidence: 99%

A 41-Year-Old African American Man With Poorly Controlled Hypertension

Cooper¹

2009

JAMA

View full text Add to dashboard Cite

Mr R is a 41-year-old African American man with a long history of hypertension, first discovered in the early 1990s. Over the years, Mr R has had difficulty adhering to suggested medication regimens and his blood pressure has been poorly controlled, despite the efforts of multiple physicians at a number of different institutions.With blood pressures as high as 240/180 mm Hg in the past, Mr R's medical history is remarkable for episodes of epistaxis, headache, and occasional palpitations. Hospitalized for accelerating hypertension in 1994, he has been troubled over the years by adverse effects from a number of medications. Hydrochlorothiazide interfered with his sexual function, and ␤-blockers made him feel "sluggish mentally." He tried acupuncture but found it unhelpful.A self-employed businessman, Mr R has commercial health insurance that partially covers the costs of his medications. He works long and irregular hours. He is a single father with 2 children, one of whom lives with him. He has never smoked and uses little alcohol. The CAGE questionnaire, 1 a screening test for alcohol abuse, was performed and was negative. He is physically fit and exercises intermittently. His mother has hypertension but his siblings do not.On recent physical examination, Mr R looked well. His blood pressure was 146/74 mm Hg in the right arm and 144/72 mm Hg in the left arm. His pulse was 64/min and regular; respirations, 10/min. He weighed 210 lb, and his height was 72 in. His eye grounds were unremarkable, lungs clear, veins flat. Carotid arteriesdemonstratednormalpulsationsandnobruitswereheard. Cardiac examination revealed a grade 2/6 holosystolic murmur at the base, accentuated with a Valsalva maneuver. There was no heave, rub, or gallop. Abdominal examination revealed no organomegaly, bruits, or hepatojugular reflux. He exhibited no peripheral edema or neurological abnormalities.Results of complete blood cell count and serum tests for electrolytes, creatinine, urea nitrogen, and random glucose were normal. Urinalysis and prostate-specific antigen results were normal. A fasting, calculated low-density lipoprotein level was 104 mg/dL (2.69 mmol/L). An electrocardiogram revealed voltage criteria and ST-T changes compatible with left ventricular hypertrophy. A chest film revealed mild cardiomegaly, with CME available online at www.jamaarchivescme.com and questions on p 1296.Mr R is an African American man with a long history of poorly controlled hypertension and difficulties with adherence to recommended treatments. Despite serious complications such as hypertensive emergency requiring hospitalization and awareness of the seriousness of his illness, Mr R says at times he has ignored his high blood pressure and his physicians' recommendations. African Americans are disproportionately affected by hypertension and its complications. Although most pharmacological and dietary therapies for hypertension are similarly efficacious for African Americans and whites, disparities in hypertension treatment persist. Like many patients, Mr R fa...

show abstract

A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study

Cited by 24 publications

References 14 publications

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

Implementing a palm pilot intervention for primary care providers: Lessons learned

A 41-Year-Old African American Man With Poorly Controlled Hypertension

Contact Info

Product

Resources

About