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Author List:
Kressin NR (Center for Health Quality, Outcomes & Economic Research)
Long J (Center for Health Equity Research and Promotion)
Rothendler J (Center for Health Quality, Outcomes & Economic Research)
Orner MB (Center for Health Quality, Outcomes & Economic Research)
Clark C (Chicago, Westside VAMC)
Reddy S (Chicago Westside VAMC)
Kroupa L (St. Louis VAMC)
Bokhour BG (Center for Health Quality, Outcomes & Economic Research)
Kozak W (Center for Health Quality, Outcomes & Economic Research)
Berlowitz D (Center for Health Quality, Outcomes & Economic Research)
Objectives:
Blood pressure (BP) control remains a challenge, and racial disparities in control rates persist. We examined the effects of two different interventions on BP control, overall, by race, and intervention arm.
Methods:
We conducted a randomized controlled trial at 3 VAMCs to compare the effects of the VA National CPRS hypertension reminder, vs. brief communication skills training designed to improve provider-patient communication about BP medication adherence (Patient centered counseling; Ockene et al.) + CPRS reminder, vs. usual care. We identified 5,955 White (W) and African American (AA) veterans with uncontrolled BP at baseline at 3 VAMCs: control group (C), reminder only (RO), and reminder + provider training (R+T). We assessed patients’ BP before and after the interventions.
Results:
33% of the sample was white; average age was 67. At follow up, all study arms showed improved BP control, with some notable differences. After adjustment for age, BMI, and comorbid conditions, the changes in overall BP control, systolic BP (SBP) and diastolic BP (DBP) were significantly greater for Ws compared to AAs (rates of High BP dropped 40% for Ws vs. 36% for AAs; SBP dropped 12 mm Hg for Ws vs. 11 for AAs, and DBP dropped 7 mm Hg for Ws vs. 4 for AAs; all p’s <.05). In addition, although there was no significant effect for the intervention on BP control rates by study arm, there were differences by study arm on SBP and DBP. After adjustment, the mean drop in SBP for the Control site vs. RO was 13 mm Hg vs. 11; the mean drop in DBP for the Control site vs. R+T averaged 4 mm Hg vs. 5 (p’s<.05).
Implications:
BP improved overall, but the interventions had differential effects, depending on the outcomes assessed. Findings indicate that the reminder + training intervention had a small but significant effect on diastolic BP. Also, there was consistently more improvement in Ws’ BP levels, regardless of the BP measure used, suggesting that these interventions were more successful in W than AA patients.
Impacts:
These relatively low cost interventions warrant further consideration in VA.
