Roumie Christianne L, Elasy Tom A, Greevy Robert, Griffin Marie R, Liu Xulei, Stone William J, Wallston Kenneth A, Dittus Robert S, Alvarez Vincent, Cobb Janice, Speroff Theodore
Tennessee Valley Healthcare System, Vanderbilt University, and the Veterans Administration Medical Center, Nashville, Tennessee 37212, USA.
Ann Intern Med. 2006 Aug 1;145(3):165-75. doi: 10.7326/0003-4819-145-3-200608010-00004.
Inadequate blood pressure control is a persistent gap in quality care.
To evaluate provider and patient interventions to improve blood pressure control.
Cluster randomized, controlled trial.
2 hospital-based and 8 community-based clinics in the Veterans Affairs Tennessee Valley Healthcare System.
1341 veterans with essential hypertension cared for by 182 providers. Eligible patients had 2 or more blood pressure measurements greater than 140/90 mm Hg in a 6-month period and were taking a single antihypertensive agent.
Providers who cared for eligible patients were randomly assigned to receive an e-mail with a Web-based link to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines (provider education); provider education and a patient-specific hypertension computerized alert (provider education and alert); or provider education, hypertension alert, and patient education, in which patients were sent a letter advocating drug adherence, lifestyle modification, and conversations with providers (patient education).
Proportion of patients with a systolic blood pressure less than 140 mm Hg at 6 months; intensification of antihypertensive medication.
Mean baseline blood pressure was 157/83 mm Hg with no differences between groups (P = 0.105). Six-month follow-up data were available for 975 patients (73%). Patients of providers who were randomly assigned to the patient education group had better blood pressure control (138/75 mm Hg) than those in the provider education and alert or provider education alone groups (146/76 mm Hg and 145/78 mm Hg, respectively). More patients in the patient education group had a systolic blood pressure of 140 mm Hg or less compared with those in the provider education or provider education and alert groups (adjusted relative risk for the patient education group compared with the provider education alone group, 1.31 [95% CI, 1.06 to 1.62]; P = 0.012).
Follow-up blood pressure measurements were missing for 27% of study patients. The study could not detect a mechanism by which patient education improved blood pressure control.
A multifactorial intervention including patient education improved blood pressure control compared with provider education alone.
血压控制不佳是优质医疗服务中持续存在的问题。
评估医疗服务提供者和患者干预措施对改善血压控制的效果。
整群随机对照试验。
田纳西河谷退伍军人事务医疗系统中的2家医院诊所和8家社区诊所。
1341名患有原发性高血压的退伍军人，由182名医疗服务提供者负责诊治。符合条件的患者在6个月内有2次或更多次血压测量值高于140/90 mmHg，且正在服用单一抗高血压药物。
负责诊治符合条件患者的医疗服务提供者被随机分配，分别接受一封包含基于网络链接的《美国国家联合委员会关于高血压预防、检测、评估和治疗的第七次报告》（JNC 7）指南的电子邮件（医疗服务提供者教育）；医疗服务提供者教育和针对患者的高血压计算机化警报（医疗服务提供者教育和警报）；或医疗服务提供者教育、高血压警报和患者教育，即向患者发送一封信，倡导药物依从性、生活方式改变以及与医疗服务提供者沟通（患者教育）。
6个月时收缩压低于140 mmHg的患者比例；抗高血压药物强化治疗情况。
平均基线血压为157/83 mmHg，组间无差异（P = 0.105）。975名患者（73%）有6个月的随访数据。随机分配到患者教育组的医疗服务提供者所诊治的患者血压控制情况更好（138/75 mmHg），优于医疗服务提供者教育和警报组或仅接受医疗服务提供者教育组的患者（分别为146/76 mmHg和145/78 mmHg）。与医疗服务提供者教育组或医疗服务提供者教育和警报组相比，患者教育组中收缩压为140 mmHg或更低的患者更多（患者教育组与仅接受医疗服务提供者教育组相比的调整相对风险为1.31 [95% CI，1.06至1.62]；P = 0.012）。
27%的研究患者缺失随访血压测量值。该研究未能发现患者教育改善血压控制的机制。
与仅进行医疗服务提供者教育相比，包括患者教育在内的多因素干预措施可改善血压控制。
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