Optimizing blood pressure control by an Information Communication Technology-supported case management (PIA study): study protocol for a cluster-randomized controlled trial of a delegation model for general practices

Abstract

Background Longitudinal hypertension control prevents heart attacks, strokes, and other cardiovascular diseases. However, 49% of patients in German family medicine practices do not reach blood pressure (BP) targets (< 140/90 mmHg). Drawing on successful international approaches, the PIA study introduces the PIA information and communication technology system (PIA-ICT) for hypertension management in primary care. The PIA-ICT comprises the PIA-App for patients and the PIA practice management center for practices. Case management includes electronic communication with patients, recall, and stepwise medication adjustments following guidelines. The system supports a physician-supervised delegation model to practice assistants. General practitioners are qualified by eLearning. Patients learn how to obtain reliable BP readings, which they communicate to the practice using the PIA-App. Methods The effectiveness of the PIA-Intervention is evaluated in a cluster-randomized study with 60 practices, 120 practice assistants, and 1020 patients. Patients in the intervention group receive the PIA-Intervention; the control group receives usual care. The primary outcome is the BP control rate (BP < 140/90 mmHg) after 12 months. Using a mixed methods approach, secondary outcomes address the acceptance on behalf of physicians, practice assistants, and patients. This includes an evaluation of the delegation model. Discussion It is hypothesized that the PIA-Intervention will improve the quality of BP care. Perspectively, it may constitute an important health service model for primary care in Germany. Trial registration German Clinical Trials Register DRKS00012680. Registered on May 10, 2019

Higher Work-Privacy Conflict and Lower Job Satisfaction in GP Leaders and Practice Assistants Working Full-Time Compared to Part-Time: Results of the IMPROVEjob Study

“…A physicians’ job satisfaction influences patients’ satisfaction with care [ 12 ], as well as the availability of a strong primary care workforce [ 11 , 13 ]. As a theoretical implication of our study, future research should specifically address factors such as strategies to realize well-managed working hours, e.g., by optimizing work processes and the use of delegation models [ 29 ]. On a practical level, leadership training for GP practice owners with high WPC values should be implemented to decrease work-privacy conflict, to increase job satisfaction, and to prevent adverse outcomes such as emotional exhaustion [ 30 ], burnout [ 31 ], and low life satisfaction [ 32 ].…”

Digital redesign of hypertension management with practice and patient apps for blood pressure control (PIA study): a cluster-randomised controlled trial in general practices

“…The study was designed as a cluster-randomised controlled trial (cRCT) in 60 German GP practices from the Greater Bonn region which were randomised 1:1 to an intervention group (PIA-ICT) and a waiting-list control group (usual care). The waiting list control group obtained access to PIA-ICT for 3 months after the collection of follow-up data (see Figure 1 in study protocol 15 ). Further information is published in the study protocol.…”

“…Further information is published in the study protocol. 15 Ethics approval was obtained from the Ethics Committee of the Medical Faculty of the University of Bonn (reference number: 156/18, date of approval: 02/08/2018). An advisory and review board with three international researchers in the field and one national GP specialist was implemented.…”

“…PIA is a complex intervention comprising two elements: the PIA-ICT (PIA app and PIA-PrMC) and the PIA education (eLearning/on-site training for practice teams and patients). 15 …”

“…The study protocol is published: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05660-4 . 15 …”