African Americans (AA) have the highest prevalence of hypertension (HTN) in the US, with a resultant greater HTN-related mortality compared to whites. Barriers to BP control in AA exist at 3 levels of care: the patient, the physician and the healthcare system. Using the Chronic Care Model as a framework, we sought to test the effect on BP control, of a multicomponent, multi-level intervention targeted at physicians and patients. We will conduct a clustered randomized controlled trial in which 30 Community/Migrant Health Centers (C/MHCs) will be randomized to either the intervention or usual care. A total of 990 patients with uncontrolled HTN (BP> 140/90 mm hg) will be enrolled for this trial. Components of the patient intervention includes an innovative patient education approach known as Self-Paced Programmed Instruction that will be used to educate patients on knowledge of HTN; Behavioral Counseling by trained C/MHC dieticians on lifestyle modification; and Home BP Monitoring to activate patients in their own care. The physician intervention comprises Online CME courses on management of HTN based on JNC-7 guidelines; Online HTN Rounds/Case Conferences with HTN Specialists; and Feedback to physicians on clinical performance measures via computerized decision support systems. The intervention will be delivered to patients every 3 months during regular office visits for 12 months, while the physician intervention will occur every month for the duration of the trial. Patients and physicians at the usual care C/MHCs will receive NHLBI patient education materials and print versions of JNC-7 guidelines respectively. The primary outcome is the proportion of patients with adequate BP control at 12 months in each condition as defined by JNC-7 criteria (BP<130/80 mmhg for patients with diabetes or kidney disease; and BP <140/90 mmhg for all other patients). The secondary outcomes are within-patient change in SBP and DBP from baseline to 12 months; the maintenance of the intervention effects one year after trial; and the cost effectiveness of the intervention at 12 months. The long-term goal of this project is to refine the intervention as a result of the data obtained and to develop a standardized protocol that can be integrated into the usual care procedures of the C/MHCs. Thus, maximizing the likelihood that the intervention will be translated into practice, at each of the participating Community Health Center.
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