Ogedegbe Gbenga, Tobin Jonathan N, Fernandez Senaida, Gerin William, Diaz-Gloster Marleny, Cassells Andrea, Khalida Chamanara, Pickering Thomas, Schoenthaler Antoinette, Ravenell Joseph
Department of Medicine, Division of General Internal Medicine and Center for Healthful Behavior Change, New York University School of Medicine, New York, NY 10010, USA.
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):249-56. doi: 10.1161/CIRCOUTCOMES.109.849976.
Despite strong evidence of effective interventions targeted at blood pressure (BP) control, there is little evidence on the translation of these approaches to routine clinical practice in care of hypertensive blacks. The goal of this study is to evaluate the effectiveness of a multilevel, multicomponent, evidence-based intervention compared with usual care in improving BP control among hypertensive blacks who receive care in community health centers. The primary outcomes are BP control rate at 12 months and maintenance of intervention 1 year after the trial. The secondary outcomes are within-patient change in BP from baseline to 12 months and cost-effectiveness of the intervention. Counseling African Americans to Control Hypertension (CAATCH) is a group randomized clinical trial with 2 conditions: intervention condition and usual care. Thirty community health centers were randomly assigned equally to the intervention condition group (n=15) or the usual care group (n=15). The intervention comprises 3 components targeted at patients (interactive computerized hypertension education, home BP monitoring, and monthly behavioral counseling on lifestyle modification) and 2 components targeted at physicians (monthly case rounds based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, chart audit and provision of feedback on clinical performance and patients' home BP readings). All outcomes are assessed at quarterly study visits for 1 year. Chart review is conducted at 24 months to evaluate maintenance of intervention effects and sustainability of the intervention. Poor BP control is one of the major reasons for the mortality gap between blacks and whites. Findings from this study, if successful, will provide salient information needed for translation and dissemination of evidence-based interventions targeted at BP control into clinical practice for this high-risk population.
尽管有强有力的证据表明针对血压（BP）控制的干预措施有效，但几乎没有证据表明这些方法已转化为高血压黑人患者常规临床护理实践。本研究的目的是评估一种多层次、多组分、循证干预措施与常规护理相比，在改善社区卫生中心接受治疗的高血压黑人患者血压控制方面的有效性。主要结局是12个月时的血压控制率以及试验1年后干预措施的维持情况。次要结局是患者从基线到12个月的血压变化以及干预措施的成本效益。非裔美国人控制高血压咨询（CAATCH）是一项分组随机临床试验，有两种情况：干预组和常规护理组。30个社区卫生中心被随机平均分配到干预组（n = 15）或常规护理组（n = 15）。干预措施包括针对患者的3个组分（交互式计算机化高血压教育、家庭血压监测以及每月关于生活方式改变的行为咨询）和针对医生的2个组分（根据美国预防、检测、评估与治疗高血压联合委员会指南进行每月病例讨论、图表审核以及提供关于临床绩效和患者家庭血压读数的反馈）。所有结局在为期1年的季度研究访视中进行评估。在24个月时进行图表审查，以评估干预效果的维持情况和干预措施的可持续性。血压控制不佳是黑人和白人死亡率差距的主要原因之一。如果本研究取得成功，其结果将为将针对血压控制的循证干预措施转化并推广到这一高危人群的临床实践中提供所需的重要信息。
