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Jubayer S, Akhtar J, Abrar AK, Sayem MNN, Islam S, Amin KE, Nahid MF, Bhuiyan MR, Al Mamun MA, Alim A, Amin MR, Burka D, Gupta P, Zhao D, Matsushita K, Moran AE, Choudhury SR, Gupta R. Text messaging to improve retention in hypertension care in Bangladesh. J Hum Hypertens 2024:10.1038/s41371-024-00942-1. [PMID: 39182005 DOI: 10.1038/s41371-024-00942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/10/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024]
Abstract
Visit non-attendance is a common barrier to hypertension control in low and middle-income countries (LMICs). We aimed to evaluate the effectiveness of mobile text messaging in improving visit attendance among patients with hypertension in primary healthcare facilities in Bangladesh. A randomized A/B testing study was conducted with two patient groups: (1) patients regularly attending visits (regular patients) and (2) patients overdue for their follow-up clinic visit (overdue patients). Regular patients were randomized into three groups: a cascade of three text reminders, a single text reminder, or no text reminder. Overdue patients were randomized into two groups: a single text reminder or no text reminder. 20,072 regular patients and 12,708 overdue patients were enrolled. Among regular patients, visit attendance was significantly higher in the cascade reminder group and the single reminder group compared to the no reminder group (78.2% and 76.6% vs. 74.8%, p < 0.001 and 0.027, respectively). Among overdue patients, the single reminder group had a 5.8% higher visit attendance compared to the no reminder group (26.5% vs. 20.7%, p < 0.001). The results remained consistent in multivariable analysis; adjusted prevalence ratio (PR) was 1.04 (95% CI 1.02-1.06) for the cascade reminder group and 1.02 (95% CI 1.00-1.05) for the single reminder group among regular patients. The adjusted PR for the single reminder group vs. the no reminder group among overdue patients was 1.23 (95% CI 1.15-1.33). Text message reminders are an effective strategy for improving retention of patients in hypertension treatment in LMICs, especially for patients overdue to care.
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Affiliation(s)
- Shamim Jubayer
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh.
| | - Jubaida Akhtar
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | | | - Md Noor Nabi Sayem
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Shahinul Islam
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | | | | | | | | | - Abdul Alim
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Mohammad Robed Amin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | | | - Di Zhao
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Andrew E Moran
- Resolve to Save Lives, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- University of California San Francisco, San Francisco, CA, USA
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Bryan AS, Moran AE, Mobley CM, Derington CG, Rodgers A, Zhang Y, Fontil V, Shea S, Bellows BK. Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications. J Hum Hypertens 2023; 37:985-992. [PMID: 36792728 PMCID: PMC10425570 DOI: 10.1038/s41371-023-00811-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.
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Fontil V, Khoong EC, Green BB, Ralston JD, Zhou C, Garcia F, McCulloch CE, Sarkar U, Lyles CR. Randomized trial protocol for remote monitoring for equity in advancing the control of hypertension in safety net systems (REACH-SNS) study. Contemp Clin Trials 2023; 126:107112. [PMID: 36738916 PMCID: PMC10132961 DOI: 10.1016/j.cct.2023.107112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-measured blood pressure monitoring (SMBP) is essential to effective management of hypertension. This study aims to evaluate effectiveness and implementation of SMBP that leverages: cellular-enabled home BP monitors without a need for Wi-Fi or Bluetooth; simple communication modalities such as text messaging to support patient engagement; and integration into existing team-based workflows in safety-net clinics. METHODS This study will be conducted with patients in San Francisco who are treated within a network of safety-net clinics. English and Spanish-speaking patients with diagnosed hypertension will be eligible for the trial if they have recent BP readings ≥140/90 mmHg and do not have co-morbid conditions that make home BP monitoring more complex to manage. This study will implement a three-arm randomized controlled trial to compare varying levels of implementation support: 1) cellular-enabled BP monitors (with minimal implementation support), 2) cellular-enabled BP monitors with protocol-based implementation support (text reminders for patients; aggregated BP summaries sent to primary care providers), and 3) cellular-enabled BP monitors and pharmacist-led support (pharmacist coaching and independent medication adjustments). RESULTS For the main analysis, we will use mixed effects linear regression to compare the change in primary outcome of systolic BP. Secondary outcomes include BP control (<140/90 mmHg), medication intensification, patient-reported outcomes, and implementation processes (i.e., engagement with the intervention). DISCUSSION This study will design and test a digital health intervention for use in marginalized populations treated within safety net settings, evaluating both effectiveness and implementation to advance more equitable health outcomes.
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Affiliation(s)
- Valy Fontil
- Institute for Health Excellence in Health Equity, New York University Grossman School of Medicine, United States of America; Department of Population Health, New York University Grossman School of Medicine, United States of America.
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Crystal Zhou
- Division of Cardiology, University of California San Francisco, United States of America
| | - Faviola Garcia
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America; Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America; Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
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Fontil V, Modrow MF, Cooper‐DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O'Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc 2023; 12:e024975. [PMID: 36695297 PMCID: PMC9973613 DOI: 10.1161/jaha.121.024975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023]
Abstract
Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.
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Affiliation(s)
- Valy Fontil
- University of California San FranciscoSan FranciscoCA
| | | | | | | | | | | | - Kristen Azar
- University of California San FranciscoSan FranciscoCA
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Levitz C, Jones M, Nudelman J, Cox M, Camacho D, Wielunski A, Rothman M, Tomlin J, Jaffe M. Reducing Cardiovascular Risk for Patients With Diabetes: An Evidence-Based, Population Health Management Program. J Healthc Qual 2022; 44:103-112. [PMID: 34700325 PMCID: PMC8887839 DOI: 10.1097/jhq.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Those with diabetes are at an increased risk of cardiovascular disease (CVD). Safety net clinics serve populations that bear a significant burden of disease and disparities and are a key setting in which to focus on reducing CVD. An integrated health system provided funding and technical assistance (TA) to safety net organizations (community health centers and public hospitals) in Northern California to decrease the risk of cardiovascular events for patients with diabetes. This was a program called Preventing Heart Attacks and Strokes Everyday (PHASE), which combined an evidence-based medication protocol with population health management and team-based care strategies. The TA supported organizations by sharing best practices, providing quality improvement coaching, and facilitating peer learning. A mixed-methods evaluation found that organizations involved in PHASE improved rates of blood pressure control and cardioprotective medication prescriptions for patients with diabetes. They made progress on these measures through strategies such as leveraging team-based care, providing education on evidence-based protocols, and using data to drive improvements. The evaluation concluded that financially supporting and providing focused TA to safety net organizations can help them build capacity and leverage their strengths to improve outcomes and potentially decrease the risk of heart attacks and strokes in communities.
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Bryant KB, Moran AE, Kazi DS, Zhang Y, Penko J, Ruiz-Negrón N, Coxson P, Blyler CA, Lynch K, Cohen LP, Tajeu GS, Fontil V, Moy NB, Ebinger JE, Rader F, Bibbins-Domingo K, Bellows BK. Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops. Circulation 2021; 143:2384-2394. [PMID: 33855861 PMCID: PMC8206005 DOI: 10.1161/circulationaha.120.051683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected. METHODS A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants. Program costs, total direct health care costs (2019 US dollars), and quality-adjusted life-years (QALYs) were estimated for the LABBPS intervention and control arms from a health care sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50 000 and <$150 000 per QALY gained, respectively. RESULTS At 10 years, the intervention was projected to cost an average of $2356 (95% uncertainty interval, -$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01-0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42 717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17 162 per QALY gained. The LABBPS intervention would be only intermediately cost-effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mm Hg or if pharmacist weekly time driving to barbershops increased. CONCLUSIONS Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.
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Affiliation(s)
- Kelsey B. Bryant
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Andrew E. Moran
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Yiyi Zhang
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Joanne Penko
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | | | - Pamela Coxson
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Ciantel A. Blyler
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Kathleen Lynch
- Providence Saint John’s Health Center, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Laura P. Cohen
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Gabriel S. Tajeu
- Temple University, College of Public Health, Philadelphia, PA, USA
| | - Valy Fontil
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Norma B. Moy
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Joseph E. Ebinger
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Brandon K. Bellows
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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Anderson TS, Odden MC, Penko J, Kazi DS, Bellows BK, Bibbins‐Domingo K. Characteristics of Populations Excluded From Clinical Trials Supporting Intensive Blood Pressure Control Guidelines. J Am Heart Assoc 2021; 10:e019707. [PMID: 33754796 PMCID: PMC8174340 DOI: 10.1161/jaha.120.019707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Only one third of patients recommended intensified treatment by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for high blood pressure would have been eligible for the clinical trials on which recommendations were largely based. We sought to identify characteristics of adults who would have been trial-ineligible in order to inform clinical practice and research priorities. Methods and Results We examined the proportion of adults diagnosed with hypertension who met trial inclusion and exclusion criteria, stratified by age, diabetes mellitus status, and guideline recommendations in a cross-sectional study of the National Health and Nutrition Examination Survey, 2013-2016. Of the 107.7 million adults (95% CI, 99.3-116.0 million) classified as having hypertension by the ACC/AHA guideline, 23.1% (95% CI, 20.8%-25.5%) were below the target blood pressure of 130/80 mm Hg, 22.2% (95% CI, 20.1%-24.4%) would be recommended nonpharmacologic treatment, and 54.6% (95% CI, 52.5%-56.7%) would be recommended additional pharmacotherapy. Only 20.6% (95% CI, 18.8%-22.4%) of adults with hypertension would be trial-eligible. The majority of adults <50 years were excluded because of low cardiovascular risk and lack of access to primary care. The majority of adults aged ≥70 years were excluded because of multimorbidity and limited life expectancy. Reasons for trial exclusion were similar for patients with and without diabetes mellitus. Conclusions Intensive blood pressure treatment trials were not representative of many younger adults with low cardiovascular risk and older adults with multimorbidity who are now recommended more intensive blood pressure goals.
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Affiliation(s)
- Timothy S. Anderson
- Division of General MedicineBeth Israel Deaconess Medical CenterBostonMA
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
| | - Michelle C. Odden
- Department of Epidemiology and Population HealthStanford UniversityStanfordCA
| | - Joanne Penko
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Division of CardiologyBeth Israel Deaconess Medical CenterBostonMA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General HospitalSan FranciscoCA
| | | | - Kirsten Bibbins‐Domingo
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- Division of General Internal MedicineZuckerberg San Francisco General HospitalSan FranciscoCA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General HospitalSan FranciscoCA
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Mahmood S, Jalal Z, Hadi MA, Shah KU. Association between attendance at outpatient follow-up appointments and blood pressure control among patients with hypertension. BMC Cardiovasc Disord 2020; 20:458. [PMID: 33087065 PMCID: PMC7579965 DOI: 10.1186/s12872-020-01741-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/13/2020] [Indexed: 01/23/2023] Open
Abstract
Objective The aim of this study was to assess the impact of regularity in treatment follow-up appointments on treatment outcomes among hypertensive patients attending different healthcare settings in Islamabad, Pakistan. Additionally, factors associated with regularity in treatment follow-up were also identified.
Methods A cross-sectional study was undertaken in selected primary, secondary and tertiary healthcare settings between September, 2017 and December, 2018 in Islamabad, Pakistan. A structured data collection form was used to gather sociodemographic and clinical data of recruited patients. Binary logistic regression analyses were undertaken to determine association between regularity in treatment follow-up appointments and blood pressure control and to determine covariates significantly associated with regularity in treatment follow-up appointments. Results A total of 662 patients with hypertension participated in the study. More than half 346 (52%) of the patients were females. The mean age of participants was 54 ± 12 years. Only 274 (41%) patients regularly attended treatment follow-up appointments. Regression analysis found that regular treatment follow-up was an independent predictor of controlled blood pressure (OR 1.561 [95% CI 1.102–2.211; P = 0.024]). Gender (OR 1.720 [95% CI 1.259–2.350; P = 0.001]), age (OR 1.462 [CI 95%:1.059–2.020; P = 0.021]), higher education (OR 1.7 [95% CI 1.041–2.778; P = 0.034]), entitlement to free medical care (OR 3.166 [95% CI 2.284–4.388; P = 0.0001]), treatment duration (OR 1.788 [95% CI 1.288–2.483; P = 0.001]), number of medications (OR 1.585 [95% CI 1.259–1.996; P = 0.0001]), presence of co-morbidity (OR 3.214 [95% CI 2.248–4.593; P = 0.0001]) and medication adherence (OR 6.231 [95% CI 4.264–9.106; P = 0.0001]) were significantly associated with regularity in treatment follow-up appointments. Conclusion Attendance at follow-up visits was alarmingly low among patients with hypertension in Pakistan which may explain poor treatment outcomes in patients. Evidence-based targeted interventions should be developed and implemented, considering local needs, to improve attendance at treatment follow-up appointments.
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Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan.
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Bryant KB, Sheppard JP, Ruiz-Negrón N, Kronish IM, Fontil V, King JB, Pletcher MJ, Bibbins-Domingo K, Moran AE, McManus RJ, Bellows BK. Impact of Self-Monitoring of Blood Pressure on Processes of Hypertension Care and Long-Term Blood Pressure Control. J Am Heart Assoc 2020; 9:e016174. [PMID: 32696695 PMCID: PMC7792261 DOI: 10.1161/jaha.120.016174] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes. Methods and Results We pooled individual participant data from 4 randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, SD 9.5), male (53.9%), and predominantly white (95.6%); mean baseline BP was 151.8/85.0 mm Hg. Compared with usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% CI 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mm Hg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to 5 years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively. Conclusions One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at 5 years; continuing SMBP for 5 years could further improve BP control.
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Affiliation(s)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
| | | | | | - Valy Fontil
- University of California at San Francisco CA
| | | | | | | | | | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
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Narang B, Mirpuri S, Kim SY, Jutagir DR, Gany F. Lurking in plain sight: Hypertension awareness and treatment among New York City taxi/for-hire vehicle drivers. J Clin Hypertens (Greenwich) 2020; 22:962-969. [PMID: 32436644 PMCID: PMC8029946 DOI: 10.1111/jch.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/13/2020] [Accepted: 03/27/2020] [Indexed: 11/29/2022]
Abstract
Hypertension is a risk factor for cardiovascular disease, which is the leading cause of death in the United States. Taxi and for-hire vehicle (FHV) drivers, a largely male, immigrant and medically underserved population, are at increased risk of cardiovascular disease, in part due to the nature of their work. This study examined demographic and lifestyle predictors of hypertension diagnosis awareness, objectively measured blood pressure (hypertensive-range vs non-hypertensive-range readings), medication use, and hypertension control. A cross-sectional assessment was conducted with 983 male taxi/FHV drivers who attended health fairs in New York City from 2010 to 2017. Twenty-three percent self-reported a hypertension history and 46% had hypertensive-range BP readings. Approximately, half the drivers lacked health insurance (47%) and a usual care source (46%). Thirty percent did not self-report hypertension and had hypertensive-range BP readings. Medication use was reported by 69% of hypertension-aware drivers, and being older and having health care access (insurance, a usual care source, and seeing a doctor in the past year) was significantly associated with medication use. Hypertension-unaware drivers with hypertensive-range BP readings were less likely to have a usual care source. Over 60% of drivers who were hypertension-aware and on medication had hypertensive-range readings. There is a need for community-based and workplace driver and provider interventions to address BP awareness and management and to provide health care navigation for vulnerable populations such as taxi/FHV vehicle drivers.
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Affiliation(s)
- Bharat Narang
- Immigrant Health and Cancer Disparities ServiceDepartment of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Sheena Mirpuri
- Immigrant Health and Cancer Disparities ServiceDepartment of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Soo Young Kim
- Immigrant Health and Cancer Disparities ServiceDepartment of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Devika R. Jutagir
- Immigrant Health and Cancer Disparities ServiceDepartment of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities ServiceDepartment of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Department of MedicineDepartment of Public HealthWeill Cornell Medical CollegeNew YorkNYUSA
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Betjemann J, Hemphill JC, Sarkar U. We Dropped the Reflex Hammer on Hypertension 20 Years Ago-Reply. JAMA Neurol 2020; 77:526-527. [PMID: 32119033 DOI: 10.1001/jamaneurol.2020.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John Betjemann
- Department of Neurology, University of California, San Francisco, San Francisco.,Web Editor
| | - J Claude Hemphill
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Urmimala Sarkar
- Zuckerberg San Francisco General Hospital, Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, San Francisco
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12
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Pletcher MJ, Fontil V, Carton T, Shaw KM, Smith M, Choi S, Todd J, Chamberlain AM, O’Brien EC, Faulkner M, Maeztu C, Wozniak G, Rakotz M, Shay CM, Cooper RM. The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials. Circ Cardiovasc Qual Outcomes 2020; 13:e006115. [PMID: 32142371 PMCID: PMC10681810 DOI: 10.1161/circoutcomes.119.006115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. METHODS AND RESULTS The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. CONCLUSIONS The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Thomas Carton
- University of Florida, College of Medicine, Gainesville, FL
| | | | - Myra Smith
- University of Florida, College of Medicine, Gainesville, FL
| | - Sujung Choi
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | | | | | - Emily C. O’Brien
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | - Madelaine Faulkner
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | | | | | - Christina M. Shay
- Center for Health Metrics and Evaluation, American Heart Association
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13
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Fontil V, Gupta R, Moise N, Chen E, Guzman D, McCulloch CE, Bibbins-Domingo K. Adapting and Evaluating a Health System Intervention From Kaiser Permanente to Improve Hypertension Management and Control in a Large Network of Safety-Net Clinics. Circ Cardiovasc Qual Outcomes 2019; 11:e004386. [PMID: 30002140 DOI: 10.1161/circoutcomes.117.004386] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%. METHODS AND RESULTS We adapted Kaiser Permanente's evidence-based treatment protocols in a racially and ethnically diverse population at 12 safety-net clinics in the San Francisco Health Network. The intervention consisted of 4 elements: a hypertension registry, a simplified treatment intensification protocol that included fixed-dose combination medications containing diuretics, standardized BP measurement protocol, and BP check visits led by registered nurse and pharmacist staff. The study population comprised patients with hypertension who made ≥1 primary care visits within the past 24 months (n=15 917) and had a recorded BP measurement within the past 12 months. We conducted a postintervention time series analysis from August 2014 to August 2016 to assess the effect of the intervention on BP control for 24 months for the pilot site and for 15 months for 11 other San Francisco Health Network clinics combined. Secondary outcomes were changes in use of guideline-recommended medication prescribing. Rates of BP control increased at the pilot site (68%-74%; P<0.01) and the 11 other San Francisco Health Network clinic sites (69%-74%; P<0.01). Statistically significant improvements in BP control rates (P<0.01) at the 11 San Francisco Health Network clinic sites occurred in all racial and ethnic groups (blacks, 60%-66%; whites, 69%-75%; Latinos, 67%-72%; Asians, 78%-82%). Use of fixed-dose combination medications increased from 10% to 13% (P<0.01), and the percentage of angiotensin-converting enzyme inhibitor prescriptions dispensed in combination with a thiazide diuretic increased from 36% to 40% (P<0.01). CONCLUSIONS Evidence-based system approaches to improving BP control can be implemented in safety-net settings and could play a pivotal role in achieving improved population BP control and reducing hypertension disparities.
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Affiliation(s)
- Valy Fontil
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.) .,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
| | - Reena Gupta
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.)
| | - Nathalie Moise
- Department of Medicine, Columbia University Medical Center, New York, NY (N.M.)
| | - Ellen Chen
- San Francisco Department of Public Health, CA (E.C.)
| | - David Guzman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.).,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
| | | | - Kirsten Bibbins-Domingo
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.).,Department of Epidemiology and Biostatistics (C.E.M., K.B.-D.).,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
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14
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Pan J, Wu L, Wang H, Lei T, Hu B, Xue X, Li Q. Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine (Baltimore) 2019; 98:e16116. [PMID: 31277112 PMCID: PMC6635171 DOI: 10.1097/md.0000000000016116] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | - Lian Wu
- Department of Ophthalmology, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | | | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, China
| | - Bin Hu
- Department of Pharmacy, Xi’an Fourth Hospital
| | | | - Qiongge Li
- Department of Pharmacy, Xi’an Fourth Hospital
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15
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Bellows BK, Ruiz-Negrón N, Bibbins-Domingo K, King JB, Pletcher MJ, Moran AE, Fontil V. Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals. Circ Cardiovasc Qual Outcomes 2019; 12:e005624. [PMID: 31163981 DOI: 10.1161/circoutcomes.118.005624] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in US adults with hypertension by 2022. We used the validated Blood Pressure Control Model to quantify changes in clinic-based hypertension management processes needed to attain ≥80% blood pressure control. METHODS AND RESULTS The Blood Pressure Control Model simulates patient blood pressures weekly using 3 key modifiable hypertension management processes: office visit frequency, clinician treatment intensification given uncontrolled blood pressure, and continued antihypertensive medication use (medication adherence rate). We compared blood pressure control rates (using the Seventh Joint National Committee on hypertension targets) achieved over 4 years between usual care and the best-observed values for management processes identified from the literature (1-week return visit interval, 20%-44% intensification rate, and 76% adherence rate). We determined the management process values needed to achieve ≥80% blood pressure control in US adults. In adults with uncontrolled blood pressure, usual care achieved 45.6% control (95% uncertainty interval, 39.6%-52.5%) and literature-based best-observed values achieved 79.7% control (95% uncertainty interval, 79.3%-80.1%) over 4 years. Increasing treatment intensification rates to 62% of office visits with an uncontrolled blood pressure resulted in ≥80% blood pressure control, even when the return visit interval and adherence remained at usual care values. Improving to best-observed values for all 3 management processes would achieve 78.1% blood pressure control in the overall US population with hypertension, approaching the ≥80% Million Hearts 2022 goal. CONCLUSIONS Achieving the Million Hearts blood pressure control goal by 2022 will require simultaneously increasing visit frequency, overcoming therapeutic inertia, and improving patient medication adherence. As the relative importance of each of these 3 processes will depend on local characteristics, simulation models like the Blood Pressure Control Model can help local healthcare systems tailor strategies to reach local and national benchmarks.
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Affiliation(s)
- Brandon K Bellows
- Columbia University, Division of General Medicine, New York, NY (B.K.B., A.E.M.)
| | - Natalia Ruiz-Negrón
- University of Utah, Department of Pharmacotherapy, Salt Lake City, UT (N.R.-N.).,SelectHealth, Murray, UT (N.R.-N.)
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California at San Francisco (K.B.-D., M.J.P.)
| | - Jordan B King
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT (J.B.K.)
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California at San Francisco (K.B.-D., M.J.P.)
| | - Andrew E Moran
- Columbia University, Division of General Medicine, New York, NY (B.K.B., A.E.M.)
| | - Valy Fontil
- Division of General Medicine, University of California at San Francisco (V.F.)
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16
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Zuo HJ, Ma JX, Wang JW, Chen XR, Hou L. The impact of routine follow-up with health care teams on blood pressure control among patients with hypertension. J Hum Hypertens 2019; 33:466-474. [PMID: 30647461 DOI: 10.1038/s41371-018-0158-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/08/2023]
Abstract
A series of guidelines concerning hypertension emphasize the importance of follow-up in patients' management. The aim of this study was to assess the impact of routine follow-up on blood pressure (BP) control. A total of 1511 patients with hypertension aged ≥ 35 years were selected randomly from 17 communities in two cities and four townships located in Shandong and Jiangsu provinces in China. About half of the patients visited the community clinic four or more times yearly; follow-up was conducted by telephone for 43.3%. Forty-four point two percent of patients who did not visit a community clinic received telephonic follow-up; a higher percentage of telephonic follow-up was found in patients who visited community clinics frequently. Positive changes in BP level and BP control were associated with the number of clinical visits, while no significant correlations were found with telephonic follow-up. After adjustment for covariates, a higher number of clinic visits was associated with better BP control, with odds ratios of 1.628 (95% confidence interval (CI): 1.141-2.322), 1.472 (95% CI: 1.008-2.271), and 1.790 (95% CI: 1.154-2.778) for 4-6, 7-12, and >12 visits/year, respectively. Taking an antihypertensive drug showed a strong, positive association with the number of clinic visits (OR 1.747, 95% CI: 1.484-2.056). These data suggest that health care systems may achieve greater success by increasing the frequency of clinical visits and that the positive changes may be related to improvement in medication adherence. Routine follow-up by telephone was not significantly associated with BP level and BP control.
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Affiliation(s)
- Hui-Juan Zuo
- Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, 100029, Beijing, China.
| | - Ji-Xiang Ma
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, 100050, Beijing, China
| | - Jin-Wen Wang
- Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, 100029, Beijing, China
| | - Xiao-Rong Chen
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, 100050, Beijing, China
| | - Lei Hou
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, 100050, Beijing, China
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17
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Carroll JK, Fiscella K, Cassells A, Sanders MR, Williams SK, D’Orazio B, Holder T, Farah S, Khalida C, Tobin JN. Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling. J Health Care Poor Underserved 2018; 29:975-983. [PMID: 30122677 PMCID: PMC6849373 DOI: 10.1353/hpu.2018.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.
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Affiliation(s)
- Jennifer K Carroll
- Department of Family Medicine, University of Colorado, Aurora, CO, USA
- Clinical Directors Network, Inc., New York, NY, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mechelle R Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Subrina Farah
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
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18
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Fontil V, Bibbins‐Domingo K, Nguyen OK, Guzman D, Goldman LE. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices. Health Serv Res 2017; 52:807-825. [PMID: 27283354 PMCID: PMC5346492 DOI: 10.1111/1475-6773.12516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To examine adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices. DATA SOURCES/STUDY SETTING National Ambulatory Medical Care Survey from 2006 to 2010. STUDY DESIGN We examined four guideline-concordant treatment practices: initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHC with private physicians' offices overall and by payer group. DATA COLLECTION/EXTRACTION METHODS We identified visits of nonpregnant adults with hypertension at CHCs and private physicians' offices. PRINCIPAL FINDINGS Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95 percent CI: 0.6-1.9), whereas Medicaid patients at private physicians' offices were less likely to receive a new medication (AOR 0.3, 95 percent CI: 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95 percent CI: 0.4-0.9). Thiazide use for patients was similar in both settings (AOR 0.8, 95 percent CI: 0.4-1.7). Use of aldosterone antagonists was too rare (2.1 percent at CHCs and 1.5 percent at private clinics) to allow for statistically reliable comparisons. CONCLUSIONS Increasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.
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Affiliation(s)
- Valy Fontil
- Division of General Internal MedicineSan Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
- UCSF Center for Vulnerable Populations at San Francisco General HospitalSan FranciscoCA
| | - Kirsten Bibbins‐Domingo
- Division of General Internal MedicineSan Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
- UCSF Center for Vulnerable Populations at San Francisco General HospitalSan FranciscoCA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
| | - Oanh Kieu Nguyen
- Divisions of General Internal Medicine and Outcomes and Health Services ResearchUT SouthwesternDallasTX
| | - David Guzman
- Division of General Internal MedicineSan Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
| | - Lauren Elizabeth Goldman
- Division of General Internal MedicineSan Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
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19
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Pan J, Lei T, Hu B, Li Q. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence 2017; 11:1915-1922. [PMID: 29200832 PMCID: PMC5700759 DOI: 10.2147/ppa.s147605] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the knowledge of hypertension (HTN) and investigate risk factors associated with medication adherence among hypertensive stroke patients after discharge in northwestern China. PATIENTS AND METHODS A cross-sectional study involving 440 Chinese hypertensive stroke patients was conducted in a tertiary hospital in Xi'an, China. Data were collected by telephone interviews and patients' medical records. RESULTS It was found that 35.23% of patients were compliant with their antihypertensive drug treatments, and 42.95%, 52.27% and 4.77% of patients had poor, moderate and adequate knowledge of HTN, respectively. Gender, blood pressure (BP) categories, BP monitoring and HTN knowledge were independently associated with antihypertensive medication adherence. CONCLUSION The medication adherence among hypertensive stroke patients in northwestern China was poor. Knowledge of HTN was suboptimal. More attention and effective strategies should be designed to the factors affecting medication adherence. As knowledge positively affects medication adherence, clinical pharmacists should play an important role in patients' medication education.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy
- Correspondence: Jingjing Pan, Department of Pharmacy, Xi’an Fourth Hospital, 21 JieFang Road, 710004 Xi’an, People’s Republic of China, Tel +86 029 8748 0635 ext 029, Email
| | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, People’s Republic of China
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20
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Fang J, Zhao G, Wang G, Ayala C, Loustalot F. Insurance Status Among Adults With Hypertension-The Impact of Underinsurance. J Am Heart Assoc 2016; 5:JAHA.116.004313. [PMID: 28003253 PMCID: PMC5210449 DOI: 10.1161/jaha.116.004313] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertension is a major risk factor for heart disease and stroke. Health insurance coverage affects hypertension treatment and control, but limited information is available for US adults with hypertension who are classified as underinsured. Methods and Results Using Behavioral Risk Factor Surveillance System 2013 data, we identified adults with self‐reported hypertension. On the basis of self‐reported health insurance status and health care–related financial burdens, participants were categorized as uninsured, underinsured, or adequately insured. Proxies for health care received included whether they reported taking antihypertensive medications and whether they visited a doctor for a routine checkup in the past year. We assessed the association between health insurance status and health care received, adjusting for selected sociodemographic characteristics. Among 123 257 participants from 38 states and District of Columbia with self‐reported hypertension, 12% were uninsured, 26% were underinsured, and 62% were adequately insured. In adjusted models using adequately insured participants as referent, both uninsured (adjusted odds ratio, 0.39; 95% CI, 0.35–0.43) and underinsured (0.83, 0.76–0.89) participants were less likely to report using antihypertensive medication than those of adequately insured participants. Similarly, adjusted odds ratio of visiting a doctor for routine checkup in the past year were 0.25 (0.23–0.28) for those who were uninsured and 0.78 (0.72–0.84) for those who were underinsured compared to those with adequate insurance. Conclusions Uninsured and underinsured participants with hypertension were less likely to report receiving care compared to those with adequate insurance coverage. Disparities in health care coverage may necessitate targeted interventions, even among people with health insurance.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Guixiang Zhao
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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21
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Pawloski PA, Asche SE, Trower NK, Bergdall AR, Dehmer SP, Maciosek MV, Nyboer RA, O'Connor PJ, Sperl-Hillen JM, Green BB, Margolis KL. A substudy evaluating treatment intensification on medication adherence among hypertensive patients receiving home blood pressure telemonitoring and pharmacist management. J Clin Pharm Ther 2016; 41:493-8. [PMID: 27363822 DOI: 10.1111/jcpt.12414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 06/02/2016] [Indexed: 01/07/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hypertension is a leading cause of death and major contributor to heart attacks, strokes, heart and kidney failure. Antihypertensive (HTN medication) non-adherence contributes to uncontrolled hypertension. Effective initiatives to improve uncontrolled hypertension include a team-based approach with home blood pressure (BP) monitoring. Our study objective was to evaluate whether objectively measured medication adherence was influenced by home BP telemonitoring and pharmacist management. METHODS We analysed HTN medication adherence in 240 patients who received home BP telemonitoring and pharmacist intervention (TI). Adherence was measured based on prescription fills and the proportion of days covered (PDC). HTN medications continued pre- to post-baseline were similar for telemonitoring intervention (TI) and usual care (UC) patients (rate ratio = 1·00, P = 0·90). RESULTS AND DISCUSSION More HTN medications were discontinued pre- to post-baseline in TI patients (rate ratio = 1·38, P = 0·04). Similarly, more HTN medications were added in TI patients (rate ratio = 2·46, P < 0·001). The proportion with a mean PDC ≥ 0·8 for HTN medications added after baseline and overall adherence did not differ between groups. WHAT IS NEW AND CONCLUSION Medication adherence was high in both groups; however, medication adherence was not significantly altered by the intervention. There were more medication modifications and greater medication intensification among TI patients.
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Affiliation(s)
| | - S E Asche
- HealthPartners Institute, Minneapolis, MN, USA
| | - N K Trower
- HealthPartners Institute, Minneapolis, MN, USA
| | | | - S P Dehmer
- HealthPartners Institute, Minneapolis, MN, USA
| | | | - R A Nyboer
- HealthPartners Institute, Minneapolis, MN, USA
| | | | | | - B B Green
- Group Health Research Institute, Seattle, WA, USA
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22
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Fiscella K, Ogedegbe G, He H, Carroll J, Cassells A, Sanders M, Khalida C, D'Orazio B, Tobin JN. Blood Pressure Visit Intensification Study in Treatment: Trial design. Am Heart J 2015; 170:1202-10. [PMID: 26678642 PMCID: PMC4684589 DOI: 10.1016/j.ahj.2015.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a presumption that, for patients with uncontrolled blood pressure (BP), early follow-up, that is, within 4 weeks of an elevated reading, improves BP control. However, data are lacking regarding effective interventions for increasing clinician frequency of follow-up visits and whether such interventions improve BP control. METHODS/DESIGN Blood Pressure Visit Intensification Study in Treatment involves a multimodal approach to improving intensity of follow-up in 12 community health centers using a stepped wedge study design. DISCUSSION The study will inform effective interventions for increasing frequency of follow-up visits among patients with uncontrolled BP and determine whether increasing follow-up frequency is associated with better BP control.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY.
| | - Gbenga Ogedegbe
- Department of Population Health, Langone Medical Center, New York University, New York, NY
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Jennifer Carroll
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
| | | | | | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY; Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, Bronx, NY; The Rockefeller University Center for Clinical and Translational Science, New York, NY
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