TY - JOUR
T1 - A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients
AU - Cooper, Lisa A.
AU - Roter, Debra
AU - Carson, Kathryn A.
AU - Bone, Lee R.
AU - Larson, Susan M
AU - Miller, Edgar R.
AU - Barr, Michael S.
AU - Levine, David M.
N1 - Funding Information:
Funders: This work was supported by a grant from the National Heart, Lung, and Blood Institute (R01HL69403).
Funding Information:
Conflict of Interest: Drs. Cooper and Roter have served as consultants for Talaria, Inc. Dr. Roter and Mrs. Larson are owners of RIASWorks LLC, a company that provides Roter Interaction Analysis System coding services to clients outside of the Johns Hopkins University System. It may be possible that the company will benefit indirectly from dissemination of the current research. Dr. Barr has received grants from Pfizer, Inc, UnitedHealth Care, NovoNordisk, Merck, Wyeth, Sanofi, and Endo. All other authors declare that they have no conflicts to disclose.
Funding Information:
This study was conducted with grant support from the National Heart, Lung, and Blood Institute (NHLBI). The NHLBI had no role in the design, conduct, or reporting of the study.
PY - 2011/11
Y1 - 2011/11
N2 - BACKGROUND: African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations. OBJECTIVE: To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups. DESIGN: Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland. PARTICIPANTS: Forty-one primary care physicians and 279 hypertension patients. INTERVENTIONS: Physician communication skills training and patient coaching by community health workers. MAIN MEASURES: Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control. KEY RESULTS: Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p=0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β=+6.20 vs. -5.24, p=0.03) and PIC dimensions related to doctor facilitation (β=+0.22 vs. -0.17, p=0.03) and information exchange (β=+0.32 vs. -0.22, p=0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg). CONCLUSION: Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.
AB - BACKGROUND: African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations. OBJECTIVE: To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups. DESIGN: Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland. PARTICIPANTS: Forty-one primary care physicians and 279 hypertension patients. INTERVENTIONS: Physician communication skills training and patient coaching by community health workers. MAIN MEASURES: Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control. KEY RESULTS: Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p=0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β=+6.20 vs. -5.24, p=0.03) and PIC dimensions related to doctor facilitation (β=+0.22 vs. -0.17, p=0.03) and information exchange (β=+0.32 vs. -0.22, p=0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg). CONCLUSION: Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.
KW - hypertension
KW - patient-centered care
KW - patient-physician communication
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U2 - 10.1007/s11606-011-1794-6
DO - 10.1007/s11606-011-1794-6
M3 - Article
C2 - 21732195
AN - SCOPUS:80755128439
SN - 0884-8734
VL - 26
SP - 1297
EP - 1304
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 11
ER -