A quasi-experimental test of an intervention to increase the use of thiazide-based treatment regimens for people with hypertension

Ashton, Carol M.; Khan, Myrna M.; Johnson, Michael L.; Walder, Annette; Stanberry, Elizabeth; Beyth, Rebecca J.; Collins, Tracie C.; Gordon, Howard S.; Haidet, Paul; Kimmel, Barbara; Kolpakchi, Anna; Lu, Lee; Naik, Aanand D.; Petersen, Laura A.; Singh, Hardeep; Wray, Nelda P.

doi:10.1186/1748-5908-2-5

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…Furthermore, two-thirds of patients without diabetes achieved hypertension control, including over 80% of those who adhered to the group-clinic protocol. Among protocol adherent patients, rates of hypertension control for diabetics and non-diabetics were significantly higher when compared with similar groups drawn from the overall primary care clinic during this same time period, as previously described 6. Adherence to the QI initiative protocol was the most powerful predictor of hypertension control for all patients during the follow-up period, including those with diabetes.…”

Section: Summary Of the Experience And Future Directionssupporting

confidence: 67%

“…These results were also not compared with patients in a concurrent, usual care group. However, rates of hypertension control in primary care at the MEDVAMC during the same time period of the QI initiative have been previously published 6. Finally, all included patients had uncontrolled hypertension within three months prior to the QI initiative; and BP measurements were recorded for up to ten months after completing the QI protocol, allowing for robust pre-post comparisons.…”

Section: Summary Of the Experience And Future Directionsmentioning

confidence: 99%

See 1 more Smart Citation

Quality Improvement Initiative for Rapid Induction of Hypertension Control in Primary Care

Naik

Rodriguez²,

Rao

et al. 2010

Circ: Cardiovascular Quality and Outcomes

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Section: Summary Of the Experience And Future Directionssupporting

confidence: 67%

Section: Summary Of the Experience And Future Directionsmentioning

confidence: 99%

Quality Improvement Initiative for Rapid Induction of Hypertension Control in Primary Care

Naik

Rodriguez²,

Rao

et al. 2010

Circ: Cardiovascular Quality and Outcomes

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“…The role afforded the context varies, from studies (e.g. [ 74 - 77 ]) that essentially view the context in terms of a physical “environment or setting in which the proposed change is to be implemented” ([ 5 ]:150) to studies (e.g. [ 21 , 74 , 78 ]) that assume that the context is something more active and dynamic that greatly affects the implementation process and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[ 74 - 77 ]) that essentially view the context in terms of a physical “environment or setting in which the proposed change is to be implemented” ([ 5 ]:150) to studies (e.g. [ 21 , 74 , 78 ]) that assume that the context is something more active and dynamic that greatly affects the implementation process and outcomes. Hence, although implementation science researchers agree that the context is a critically important concept for understanding and explaining implementation, there is a lack of consensus regarding how this concept should be interpreted, in what ways the context is manifested and the means by which contextual influences might be captured in research.…”

Section: Discussionmentioning

confidence: 99%

Making sense of implementation theories, models and frameworks

2015

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BackgroundImplementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers.DiscussionTheoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks).SummaryThis article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

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“…[25][26][27][28][29] While NAMCS data cannot reliably help us distinguish between these explanations, systems that provide care for similarly older populations, such as the Veterans Health Administration (VHA), have been able to successfully increase thiazide use in their overall hypertensive patient population. 30 This suggests that there may be room for increased thiazide use among resistant hypertension patients in the U.S population. Longitudinal observational studies are needed to better assess appropriate use and identify potential strategies for safe increase of thiazide use in resistant hypertension.…”

Section: Discussionmentioning

confidence: 99%

Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006–2010

et al. 2013

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BACKGROUND:The American Heart Association (AHA) published guidelines for treatment of resistant hypertension in 2008 recommending use of thiazide diuretics (particularly chlorthalidone), aldosterone antagonists, and fixed-dose combination medications, but it is unclear the extent to which these guidelines are being followed. OBJECTIVE: To describe trends in physician use of recommended medications for resistant hypertension and assess variations in medication use based on geography, physician specialty and patient characteristics. DESIGN: Cross-sectional analysis using the National Ambulatory Medical Care Survey from 2006 to 2010. STUDY SAMPLE: We analyzed visits of hypertension patients to family physicians, general internists, and cardiologists. Resistant hypertension was defined as concurrent use of ≥ 4 classes of blood pressure (BP) medications or elevated BP despite the use of ≥ 3 medications. Pregnant patients and visits with diagnosed heart failure or end-stage renal disease were excluded. MAIN OUTC OME: U se of A HA-r ec ommen d ed medications for management of resistant hypertension. RESULTS: Of 19,500 patient visits with hypertension, 1,567 or 7.1 % CI (6.6-7.7 %) met criteria for resistant hypertension. Thiazide diuretic use was reported in 58.9 % of visits pre-guidelines vs. 54.8 % postguidelines (p=0.37). Use of aldosterone antagonists was low and also did not change significantly after guideline publication (3.1 % vs. 4.5 %, p=0.27). Fixeddose combinations use was 42.0 % before and 37 % after guideline publication (p = 0.29). Each 10-year increase in patient age was associated with lower thiazide use (OR 0.87,, as was presence of comorbid ischemic heart disease (OR 0.62, CI 0.41-0.94). Medication use did not vary by geography or physician specialty. CONCLUSION: Use of AHA-recommended medications for resistant hypertension remains low after publication of guidelines. Healthcare systems should encourage more frequent prescribing of these medications to improve care in this high-risk population.

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A quasi-experimental test of an intervention to increase the use of thiazide-based treatment regimens for people with hypertension

Abstract: Background: Despite recent high-quality evidence for their cost-effectiveness, thiazides are underused for controlling hypertension. The goal of this study was to design and test a practice-based intervention aimed at increasing the use of thiazide-based antihypertensive regimens.

Cited by 9 publications

References 24 publications

Quality Improvement Initiative for Rapid Induction of Hypertension Control in Primary Care

Quality Improvement Initiative for Rapid Induction of Hypertension Control in Primary Care

Making sense of implementation theories, models and frameworks

Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006–2010

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