The objectives of this study are to improve the care of hypertensive patients provided by primary care community physicians and to improve the health status of their patients. These objectives will be accomplished through the use of the Professional Competence Assurance Program (PROCAP) which is an individualize approach to education based upon feedback of physician performance and patient survey data. Two approaches are used in hypertension treatment: medical management according to stepped care medication use and behavioral management to improve quality of non drug treatment and patient compliance with the regimen. There are three treatment groups. In Groups I and II each approach is tested separately to measure its relative contribution, and in Group III both are tested together to provide a comprehensive approach to treatment. All three groups are compared to an untreated control (Group IV). PROCAP uses two methods to obtain needs assessment data: (1) medical record review to measure physician performance and (2) a survey, sent by the physicial, to measure patient behavior. The educational intervention is a feedback report of survey and record data which compares the individual physician to peers. This report serves to motivate the physician to change his/her behavior. The report is accompanied by a syllabus and a telephone conference call. The latter occurs among 3 to 5 participants with similar levels of performance and a faculty expert who has reviewed their reports, so as to tailor the educational content of the call. Reassessment occurs one year later. It is expected that physicians receiving the stepped care interventions, Group I and III, will improve their use of medications. They will also monitor side effects more often and respond appropriately to abnormal chemical and symptomatic side effects. Their patients may report fewer side effects. Patients of physicians receiving the behavioral education intervention, Groups II and III, will consume less sodium, be more compliant with medications, and will be more likely to know their blood pressure levels. Obese patients will also show a greater weight loss. All patients in the three experimental groups will have better diastolic blood pressure control (Less than 90 mm Hg) and patients in the combined treatment group, Group III, will demonstrate the highest level of control.
| Tschann, J M; Adamson, T E; Coates, T J et al. (1988) Behaviors of treated hypertensive patients and patient demographic characteristics. J Community Health 13:19-32 |
