0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Improving Blood Pressure Control through Provider Education, Provider Alerts, and Patient Education: A Cluster Randomized Trial

Christianne L. Roumie, MD, MPH; Tom A. Elasy, MD, MPH; Robert Greevy, PhD; Marie R. Griffin, MD, MPH; Xulei Liu, MD, MS; William J. Stone, MD; Kenneth A. Wallston, PhD; Robert S. Dittus, MD, MPH; Vincent Alvarez, MD; Janice Cobb, RN; and Theodore Speroff, PhD
[+] Article and Author Information

Clinicaltrials.gov Identifier: NCT00265044


From Tennessee Valley Healthcare System, Vanderbilt University, and the Veterans Administration Medical Center, Nashville, Tennessee.


Grant Support: By the Veterans Affairs Clinical Research Center of Excellence (Drs. Roumie, Elasy, Greevy, Griffin, Dittus, and Speroff); VA Career Development Award 04-342-2 (Dr. Roumie); HSR&D Targeted Research Enhancement Program Center for Patient Healthcare Behavior TRP 03-073 (Drs. Roumie, Elasy, Greevy, Griffin, Wallston, Dittus, Alvarez, and Speroff and Ms. Cobb); Geriatric Research Education and Clinical Center, Veterans Affairs, Tennessee Valley Healthcare, Nashville, Tennessee (Drs. Roumie, Elasy, Griffin, Wallston, Dittus, and Speroff); and Health Services Research–VISN Cooperative Grant for Improving Implementation of Best Practices (IMV 04-091-1) (Drs. Roumie, Wallston, Alvarez, and Speroff and Ms. Cobb).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Christianne L. Roumie, MD, MPH, Tennessee Valley Healthcare System, 1310 24th Avenue South, GRECC 4A120, Nashville, TN 37212; e-mail, christianne.roumie@vanderbilt.edu.

Current Author Addresses: Drs. Roumie, Elasy, Griffin, Stone, Alvarez, and Speroff and Ms. Cobb: Tennessee Valley Healthcare System, 1310 24th Avenue South, GRECC 4A120, Nashville, TN 37212.

Drs. Greevy and Liu: Vanderbilt University, 1161 21st Avenue South, S-2323 MCN, Nashville, TN 37232.

Dr. Wallston: Vanderbilt University, 421 Godchuk Hall, Nashville, TN 37240.

Dr. Dittus: Vanderbilt University, 1215 21st Avenue South, Suite 6000, Medical Center East, Nashville, TN 37232.

Author Contributions: Conception and design: C.L. Roumie, T.A. Elasy, M.R. Griffin, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.

Analysis and interpretation of the data: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, K.A. Wallston, R.S. Dittus, T. Speroff.

Drafting of the article: C.L. Roumie, R. Greevy.

Critical revision of the article for important intellectual content: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.

Final approval of the article: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.

Provision of study materials or patients: V. Alvarez, J. Cobb.

Statistical expertise: R. Greevy, X. Liu, T. Speroff.

Obtaining of funding: T.A. Elasy, M.R. Griffin, R.S. Dittus, T. Speroff.

Administrative, technical, or logistic support: T.A. Elasy, M.R. Griffin, W.J. Stone, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.

Collection and assembly of data: C.L. Roumie, V. Alvarez, J. Cobb.


Ann Intern Med. 2006;145(3):165-175. doi:10.7326/0003-4819-145-3-200608010-00004
Text Size: A A A

Our cluster randomized, controlled trial shows the effectiveness of adding patient education to provider education in improving blood pressure control among veterans with uncontrolled essential hypertension. Previous studies found that a strategy of provider education alone led to inconsistent results or minimal change in provider behavior (2931). Therefore, we used provider education only as the control group for our study. Patients in all 3 intervention groups had clinically significant and clinically meaningful reductions in systolic blood pressure. Those receiving patient education had an additional important reduction in blood pressure. The additional 6–mm Hg reduction in blood pressure in the provider education, alert, and patient education group has the potential to reduce cerebrovascular morbidity and mortality by 42%, coronary heart disease by 14%, and heart failure by 50% (13, 3239).

First Page Preview

View Large
First page PDF preview

Figures

Grahic Jump Location
Figure.
Study flow diagram.

*Excluded providers who cared for patients who declined chart review or those who were taking more than 1 medication at the time of chart review after randomization.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Comments on importance of drug therapy for hypertension
Posted on August 2, 2006
Munir E Nassar
An academician, without portfolio
Conflict of Interest: None Declared

It is interesting to read the paper of Christianne, L. Roumie,Tom A. and co-workers, and the "importance of improving blood pressure control through provider education...",(Ann Intern Med 2006;145:165-175), however primary care physicians and healthcare providers may be lulled that this is a completely satisfactory treatment along with monodrug therapy in treating hypertension.In addition the paper leaves a lot to be desired as far as follow up and feed back. Hence, it is important to emphasize the following points extracted from the 7th report of the Joint Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension : That drug treatment, and combination of drugs is most important to control Hypertension. Monotherapy (various individual drug therapy) showed control on average in 50 % of patients at the end of one year. Age appears to be an important factor in increasing the risk of elevating the Systolic Blood pressure Hence, combination drug therapy up to three or four drugs appear to be necessay to satisfactorily control blood pressure.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

The Effect of Educational Reminders on Blood Pressure in Veterans with Hypertension

The summary below is from the full report titled “Improving Blood Pressure Control through Provider Education, Provider Alerts, and Patient Education. A Cluster Randomized Trial.” It is in the 1 August 2006 issue of Annals of Internal Medicine (volume 145, pages 165-175). The authors are C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, and T. Speroff.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)