John James Rufus, Tannous W Kathy, Jones Amanda
Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW, Australia.
Hypertens Res. 2020 Sep;43(9):892-902. doi: 10.1038/s41440-020-0431-3. Epub 2020 Apr 1.
Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called 'WellNet' versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the 'between-group' and 'within-group' effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (-3.4 mmHg; 95% CI -5.1, -1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively.
患有高血压和其他合并症的患者有复杂的医疗保健需求,在初级保健中管理这些需求具有挑战性。然而,有强有力的证据表明,初级保健中以患者为中心的方法在管理复杂的多重疾病方面是有效的。我们旨在评估一种名为“WellNet”的以患者为中心的医疗家庭模式与标准护理对高血压患者血压(BP)结果的有效性。我们采用了队列研究设计,并设置了一个比较组和病例系列设计,以评估在澳大利亚悉尼的六个普通诊所实施的WellNet项目的“组间”和“组内”有效性。治疗组包括447名符合条件并提供同意书的患者,他们接受了由全科医生主导并整合了护理协调员的护理。比较组包括5237名在四个地理位置相当的普通诊所接受常规护理的匹配患者。为了评估随时间的变化,使用配对和独立样本t检验来确定显著差异。此外,使用协方差分析(ANCOVA)来确定在调整潜在协变量后是否存在任何显著差异。调整后的模型显示,随访时治疗组的收缩压显著降低(-3.4 mmHg;95% CI -5.1,-1.7;p值<0.001)。然而,舒张压未观察到显著的平均变化。发现治疗组中处于推荐范围内的患者比例显著高于比较组(13.6%对6.4%)。WellNet患者在随访期间血压有统计学上显著且临床上有意义的改善。这项研究的结果可能分别在改善健康结果和提供护理方面对患者和提供者都有益。