Erschienen in:
01.11.2011 | Original Research
A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients
verfasst von:
Lisa A. Cooper, MD, MPH, Debra L. Roter, DrPH, Kathryn A. Carson, ScM, Lee R. Bone, MPH, Susan M. Larson, MS, Edgar R. Miller III, MD, PhD, Michael S. Barr, MD, MBA, David M. Levine, MD, MPH, ScD
Erschienen in:
Journal of General Internal Medicine
|
Ausgabe 11/2011
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Abstract
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.