Effectiveness of Mailed Patient Activation Letters for Blood Pressure Control: A Randomized Quality Improvement Trial
- 04.11.2025
- Original Research
- Verfasst von
- Mike K. W. Cheng, MD, MAEd
- Michael O. Eseigbe, MD
- Jaime H. Orozco, BA
- Soo Park, BA
- Madelaine F. Modrow, MPH
- Valy Fontil, MD, MAS
- Mark J. Pletcher, MD, MPH
- Erschienen in
- Journal of General Internal Medicine
Abstract
Background
Uncontrolled hypertension (HTN) is a leading preventable cause of death. Interventions are needed that activate patients and motivate them to work with clinicians to control their blood pressure (BP).
Objective
To test whether mailing patients a letter including information about their hypertension and a summary of computerized algorithm-generated medication adjustment suggestions improves BP control processes and outcomes.
Design
Randomized quality improvement trial.
Participants
We identified patients receiving primary care at a large academic medical center with diagnosed HTN and uncontrolled BP (> 140 mmHg systolic or > 90 mmHg diastolic) at both of their last 2 visits.
Interventions
Participants were randomized into three groups. The BP Activate Letter group received a letter containing algorithm-generated BP medication adjustment suggestions, and a recommendation to discuss these suggestions with their provider; the Control Letter group received a letter that recommended they talk to their provider about their HTN, without specific medication suggestions; and the No Letter group received no mailed outreach.
Main Measures
The primary outcome was time to occurrence of either a BP medication intensification or documented achievement of BP control to < 140/< 90 mmHg using EHR data extracted 6 months after letters were mailed.
Key Results
The primary outcome, which was time to medication intensification or achievement of BP control, did not occur more frequently in the BP Activate Letter group (hazard ratio = 0.86; 95% confidence interval [CI]: 0.65 to 1.14), or in the Control Letter group (0.78; 0.59 to 1.03) compared to the No Letter group, and we saw no evidence of significant improvement in any secondary outcome or subgroup. Time to medication intensification appeared to be significantly longer in the Control Letter compared to the No Letter group (0.50; 0.30 to 0.85).
Conclusions
Mailing patients one letter with computerized BP medication adjustment suggestions to consider did not lead to effective patient activation.
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- Titel
- Effectiveness of Mailed Patient Activation Letters for Blood Pressure Control: A Randomized Quality Improvement Trial
- Verfasst von
-
Mike K. W. Cheng, MD, MAEd
Michael O. Eseigbe, MD
Jaime H. Orozco, BA
Soo Park, BA
Madelaine F. Modrow, MPH
Valy Fontil, MD, MAS
Mark J. Pletcher, MD, MPH
- Publikationsdatum
- 04.11.2025
- Verlag
- Springer International Publishing
- Erschienen in
-
Journal of General Internal Medicine
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497 - DOI
- https://doi.org/10.1007/s11606-025-09946-0
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