Center for Healthcare Delivery Sciences (C4HDS), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Center for Healthcare Delivery Sciences (C4HDS), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Am Heart J. 2024 Feb;268:18-28. doi: 10.1016/j.ahj.2023.11.005. Epub 2023 Nov 14.
Clinical inertia, or failure to intensify treatment when indicated, leads to suboptimal blood pressure control. Interventions to overcome inertia and increase antihypertensive prescribing have been modestly successful in part because their effectiveness varies based on characteristics of the provider, the patient, or the provider-patient interaction. Understanding for whom each intervention is most effective could help target interventions and thus increase their impact.
This three-arm, randomized trial tests the effectiveness of 2 interventions to reduce clinical inertia in hypertension prescribing compared to usual care. Forty five primary care providers (PCPs) caring for patients with hypertension in need of treatment intensification completed baseline surveys that assessed behavioral traits and were randomized to one of three arms: 1) Pharmacist e-consult, in which a clinical pharmacist provided patient-specific recommendations for hypertension medication management to PCPs in advance of upcoming visits, 2) Social norming dashboards that displayed PCP's hypertension control rates compared to those of their peers, or 3) Usual care (no intervention). The primary outcome was the rate of intensification of hypertension treatment. We will compare this outcome between study arms and then evaluate the association between characteristics of providers, patients, their clinical interactions, and intervention responsiveness.
Forty-five primary care providers were enrolled and randomized: 16 providers and 173 patients in the social norming dashboards arm, 15 providers and 143 patients in the pharmacist e-consult arm, and 14 providers and 150 patients in the usual care arm. On average, the mean patient age was 64 years, 47% were female, and 73% were white. Baseline demographic and clinical characteristics of patients were similar across arms, with the exception of more Hispanic patients in the usual care arm and fewest in the pharmacist e-consult arm.
This study can help identify interventions to reduce inertia in hypertension care and potentially identify the characteristics of patients, providers, or patient-provider interactions to understand for whom each intervention would be most beneficial.
Clinicaltrials.gov (NCT, Registered: NCT04603560).
临床惰性，即当需要强化治疗时却未能采取行动，会导致血压控制不理想。为了克服惰性并增加降压药物的处方量，已经采取了一些干预措施，但这些措施的效果并不理想，部分原因是其有效性因提供者、患者或医患互动的特征而异。了解每种干预措施对谁最有效，可以帮助确定干预措施的目标，从而提高其效果。
这项三臂随机试验测试了两种干预措施在降低高血压治疗中的临床惰性方面的有效性，与常规护理相比。45 名初级保健提供者（PCP）在需要强化治疗的高血压患者中进行了基线调查，评估了他们的行为特征，并被随机分配到以下三个组之一：1）药剂师电子咨询，其中临床药剂师在即将到来的就诊前为 PCP 提供针对高血压药物管理的患者特定建议，2）社会规范仪表盘，显示 PCP 的高血压控制率与同龄人相比，或 3）常规护理（无干预）。主要结果是高血压治疗强化的比率。我们将比较研究组之间的这一结果，然后评估提供者、患者、他们的临床互动和干预反应性的特征之间的关联。
共纳入并随机分配了 45 名初级保健提供者：社会规范仪表盘组有 16 名提供者和 173 名患者，药剂师电子咨询组有 15 名提供者和 143 名患者，常规护理组有 14 名提供者和 150 名患者。平均而言，患者的平均年龄为 64 岁，47%为女性，73%为白人。各手臂的患者基线人口统计学和临床特征相似，除了常规护理手臂中有更多的西班牙裔患者，而药剂师电子咨询手臂中患者最少。
这项研究可以帮助确定减少高血压护理惰性的干预措施，并可能确定患者、提供者或患者-提供者互动的特征，以了解每种干预措施对谁最有益。
Clinicaltrials.gov（NCT，注册：NCT04603560）。
