To improve patients' adherence with prescribed anti-hypertensive medication, blood pressure control and doctor-patient communication, and to decrease racial disparities in each, we propose a three-armed randomized controlled trial in the general internal medicine clinics of a large urban teaching hospital serving many poor African American and white patients. We will implement proven intervention strategies by teaching clinicians to use patient-centered counseling, enhancing skills that are known to help patients change health-related behaviors, and to enhance clinicians' cultural competency and thereby further improve clinician-patient communication. In one set of clinicians we will implement only the patient-centered counseling program, in a second set we will implement the patient-centered counseling education program, augmenting it with an established method for cultural competency training, and a third set (control group) will provide usual care. To assess outcomes, we will first assess the pre-intervention patient adherence to prescribed medications through patient self-report and the use of electronic pill top monitoring, clinicians' provision of advice and counseling about anti-hypertensive medications and use of cultural competency skills, and the proportion of patients with controlled blood pressure. Subsequent to the interventions, we will reassess each of these outcomes.
Our specific aims are to: 1) Improve patients' adherence to prescribed anti-hypertensive therapy; 1a. Examine adherence rates at baseline, and examine whether there are racial differences in adherence, 1b. Decrease racial disparities in patient adherence with anti-hypertensive therapy from the baseline to the follow-up assessments; 1c. Evaluate the relative efficacy of the patient-centered counseling intervention compared to patient-centered counseling augmented by cultural competency training on patients' medication adherence; 2) Increase the proportion of patients with controlled hypertension; 2a. Examine the baseline proportion of patients with controlled hypertension, and whether there are racial differences in rates of control; 2b. Decrease racial disparities in the proportion of patients with controlled hypertension from the baseline to the follow-up assessments; 2c. Evaluate the relative efficacy of patient-centered counseling compared to patient-centered counseling augmented by cultural competency training on patients' blood pressure control; 3) Improve clinicians' communication with patients regarding medication use, as measured by increased frequency of clinicians' provision of advice and counseling about anti-hypertensive medications and use of culturally competent communication styles; 3a. Examine whether there are racial disparities in clinicians' provision of advice and counseling or culturally competent communication patterns about anti-hypertensive medications at baseline; 3b. Examine whether the proposed interventions decrease any observed racial disparities in clinician communication over time; 3c. Evaluate the relative efficacy of the patient-centered counseling intervention compared to patient-centered counseling augmented by cultural competency training on clinicians' communication patterns.
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