急诊科教育与赋权干预对以少数族裔为主的人群中未控制高血压的影响：AHEAD2随机临床试验

Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial.

作者信息

Prendergast Heather, Del Rios Marina, Durazo-Arvizu Ramon, Escobar-Schulz Sandra, Heinert Sara, Jackson Maya, Gimbar Renee Petzel, Daviglus Martha, Lara Brenda, Khosla Shaveta

机构信息

Department of Emergency Medicine University of Illinois at Chicago Chicago Illinois USA.

Public Health Sciences Loyola University Chicago Maywood Illinois USA.

出版信息

J Am Coll Emerg Physicians Open. 2021 Mar 2;2(2):e12386. doi: 10.1002/emp2.12386. eCollection 2021 Apr.

DOI:10.1002/emp2.12386

PMID:33718921

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7926004/

Abstract

OBJECTIVE

To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high-risk population.

METHODS

A hypertension emergency department intervention aimed at decreasing disparities (AHEAD2) is a 3-arm, single-site randomized pilot trial for feasibility in an urban academic ED. A total of 150 predominantly ethnic minorities with no primary care provider and severely elevated blood pressure (BP) (≥160/100 mm Hg) were enrolled over 10 months. Participants were randomized into 1 of 3 study arms: (1) enhanced usual care (EUC), (2) ED-initiated screening, brief intervention, and referral for treatment (ED-SBIRT), or (3) ED- SBIRT plus a 48-72 hours post-acute care hypertension transition clinic (ED-SBIRT+PACHT-c). Primary outcomes were change in systolic and diastolic BP (SBP and DBP) from baseline to 9 months. Secondary outcomes were BP control (BP <140/90 mm Hg), changes in hypertension knowledge, medication adherence, and limited bedside echocardiogram (LBE) findings.

RESULTS

SBP reduction from baseline to month 9 was -26.8 (95% confidence interval [CI]: -32.8, -20.7) mm Hg for ED-SBIRT, -23.4 (95% CI: -29.5, -17.3) mm Hg for ED-SBIRT+PACHT-c, and -18.9 (95% CI: -24.9, -12.9) mm Hg for EUC. DBP decreased by -12.5 (95% CI: -16.1, -9.0) mm Hg for ED-SBIRT, -11.3 (95% CI: -14.8, -7.7) mm Hg for ED-SBIRT+PACHT-c, and -8.4 (95% CI: -11.9, -4.9) mm Hg for EUC. A multicomponent intervention compared with EUC resulted in SBP decrease of -7.9 mm Hg (95% CI: -16.4, 0.6). At 9 months, hypertension was controlled for 29.3% (95% CI: 20.3, 38.3) of intervention and 23.5% (95% CI: 11.9, 35.2) of EUC participants. All groups saw improvements in hypertension knowledge, medication adherence, and LBEs, with greater improvements in intervention groups.

CONCLUSIONS

The study findings suggest that a multicomponent intervention comprising of ED education and empowerment coupled with early risk assessment may help improve BP in a high-risk population.

摘要

目的

确定急诊科（ED）教育与赋权干预措施结合早期风险评估是否有助于改善高危人群的血压（BP）。

方法

旨在减少差异的高血压急诊科干预措施（AHEAD2）是一项在城市学术性急诊科进行的三臂、单中心随机试点试验，以评估其可行性。在10个月内共招募了150名主要为少数民族、没有初级保健提供者且血压严重升高（≥160/100 mmHg）的患者。参与者被随机分为3个研究组之一：（1）强化常规护理（EUC），（2）急诊科启动的筛查、简短干预和治疗转诊（ED-SBIRT），或（3）ED-SBIRT加上急性护理后48-72小时的高血压过渡诊所（ED-SBIRT+PACHT-c）。主要结局是从基线到9个月时收缩压和舒张压（SBP和DBP）的变化。次要结局包括血压控制（血压<140/90 mmHg）、高血压知识的变化、药物依从性以及有限床边超声心动图（LBE）检查结果。

结果

从基线到第9个月，ED-SBIRT组的SBP降低了-26.8（95%置信区间[CI]：-32.8，-20.7）mmHg，ED-SBIRT+PACHT-c组降低了-23.4（95%CI：-29.5，-17.3）mmHg，EUC组降低了-18.9（95%CI：-24.9，-12.9）mmHg。ED-SBIRT组的DBP降低了-12.5（95%CI：-16.1，-9.0）mmHg，ED-SBIRT+PACHT-c组降低了-11.3（95%CI：-14.8，-7.7）mmHg，EUC组降低了-8.4（95%CI：-11.9，-4.9）mmHg。与EUC相比，多组分干预使SBP降低了-7.9 mmHg（95%CI：-16.4，0.6）。在9个月时，干预组中有29.3%（95%CI：20.3，38.3）的参与者血压得到控制，EUC组中有23.5%（95%CI：11.9，35.2）的参与者血压得到控制。所有组的高血压知识、药物依从性和LBE检查结果均有所改善，干预组的改善更为明显。