Feldman Penny H, McDonald Margaret V, Mongoven Jennifer M, Peng Timothy R, Gerber Linda M, Pezzin Liliana E
Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY 10021, USA.
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):241-8. doi: 10.1161/CIRCOUTCOMES.109.849943.
Efforts to increase blood pressure (BP) control rates in blacks, a traditionally underserved high-risk population must address both provider practice and patient adherence issues. The home-based BP Intervention for blacks study is a 3-arm randomized controlled trial designed to test 2 strategies to improve hypertension management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to hypertension management recommendations and patient adherence to medication, healthy diet, and other self-management strategies. Nurses (n=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (n=845). The 2 interventions being tested are (1) a "basic" intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional postacute home health care; and (2) an "augmented" intervention that includes that same as the basic intervention, plus transition to an ongoing Hypertension Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months after baseline interview. The interventions will be assessed relative to usual care and to each other. Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low-income chronically ill patient population.
提高黑人血压控制率的努力，黑人是一个传统上服务不足的高危人群，必须解决医疗服务提供者的实践问题和患者的依从性问题。黑人家庭血压干预研究是一项三臂随机对照试验，旨在测试两种策略，以改善在为弱势和复杂的家庭护理人群提供服务的分散服务环境中的高血压管理和治疗效果。主要研究结果是收缩压、舒张压和血压控制情况；次要结果是护士对高血压管理建议的依从性以及患者对药物治疗、健康饮食和其他自我管理策略的依从性。一家非营利性的获得医疗保险认证的家庭健康机构中的护士（n = 312）及其符合条件的高血压患者（n = 845）被随机分组。正在测试的两种干预措施是：（1）一种“基本”干预措施，在患者接受传统的急性后期家庭健康护理时，向家庭护理护士和患者提供关键的循证提醒；（2）一种“强化”干预措施，包括与基本干预措施相同的内容，外加过渡到一个持续12个月的高血压家庭支持项目。在基线访谈后的3个月和12个月测量结果。将对照常规护理以及相互对照来评估干预措施。如果没有新的干预模式以及对其影响的严格评估，家庭健康领域改善血压管理和治疗效果的系统变革将不容易发生。该试验的结果将提供有关改善低收入慢性病患者人群血压控制的潜在策略的重要信息。
