Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions

Pezzin, Liliana E.; Feldman, Penny Hollander; Mongoven, Jennifer; McDonald, Margaret; Gerber, Linda M.; Peng, Timothy R.

doi:10.1007/s11606-010-1525-4

Cited by 37 publications

(53 citation statements)

References 26 publications

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“…Economic analysis was possible in six studies (eight comparisons): four comparisons [24,43] took into account only intervention operating costs, one comparison only medical costs [34] and three comparisons operating plus medical costs [31,36,41]. As expected, the expenditure was significantly (P < 0.0001) higher in the intervention than in the usual care group [þ662.92 (þ540.81, þ785.04) euros] (Fig.…”

Section: Healthcare Costsmentioning

confidence: 68%

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

Omboni¹,

Gazzola²,

Carabelli³

et al. 2013

Journal of Hypertension

273

196

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Section: Healthcare Costsmentioning

confidence: 68%

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

Omboni¹,

Gazzola²,

Carabelli³

et al. 2013

Journal of Hypertension

273

196

View full text Add to dashboard Cite

show abstract

“…This is consistent with trends seen in other clinical trials with hypertensive African American participants. For example, Pavlik et al (29) reported that, based on three National Institutes of Health (NIH)–funded cluster randomized trials of behavioral interventions for uncontrolled hypertensive African Americans (30–32), control groups are improving and can be expected to improve over the duration of a trial, due to health care initiatives in the current era of health care reform. Improvements in control conditions, as widespread, systematic interventions take place on chronic conditions, including hypertension and diabetes, have implications for researchers’ ability to detect the effectiveness of experimental study arms on outcomes that are targeted metrics in care delivery systems and surrounding communities.…”

Section: Discussionmentioning

confidence: 99%

Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial

et al. 2016

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OBJECTIVETo compare the effectiveness of three delivery modalities of Decision-making Education for Choices In Diabetes Everyday (DECIDE), a nine-module, literacy-adapted diabetes and cardiovascular disease (CVD) education and problem-solving training, compared with an enhanced usual care (UC), on clinical and behavioral outcomes among urban African Americans with type 2 diabetes.RESEARCH DESIGN AND METHODSEligible participants (n = 182) had a suboptimal CVD risk factor profile (A1C, blood pressure, and/or lipids). Participants were randomized to DECIDE Self-Study (n = 46), DECIDE Individual (n = 45), DECIDE Group (n = 46), or Enhanced UC (n = 45). Intervention duration was 18–20 weeks. Outcomes were A1C, blood pressure, lipids, problem-solving, disease knowledge, and self-care activities, all measured at baseline, 1 week, and 6 months after completion of the intervention.RESULTSDECIDE modalities and Enhanced UC did not significantly differ in clinical outcomes at 6 months postintervention. In participants with A1C ≥7.5% (58 mmol/mol) at baseline, A1C declined in each DECIDE modality at 1 week postintervention (P < 0.05) and only in Self-Study at 6 months postintervention (b = −0.24, P < 0.05). There was significant reduction in systolic blood pressure in Self-Study (b = −4.04) and Group (b = −3.59) at 6 months postintervention. Self-Study, Individual, and Enhanced UC had significant declines in LDL and Self-Study had an increase in HDL (b = 1.76, P < 0.05) at 6 months postintervention. Self-Study and Individual had a higher increase in knowledge than Enhanced UC (P < 0.05), and all arms improved in problem-solving (P < 0.01) at 6 months postintervention.CONCLUSIONSDECIDE modalities showed benefits after intervention. Self-Study demonstrated robust improvements across clinical and behavioral outcomes, suggesting program suitability for broader dissemination to populations with similar educational and literacy levels.

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“…The second involved a setting, study population, and intervention delivery that was so different from the others that inclusion in the pooled analysis was not deemed appropriate [16, 17]. In this paper we report the results of the combined analysis of three of the five trials [18–20] and discuss their implications in light of the accumulated literature on BP control interventions.…”

Section: Introductionmentioning

confidence: 99%

Designing and Evaluating Health Systems Level Hypertension Control Interventions for African-Americans: Lessons from a Pooled Analysis of Three Cluster Randomized Trials

Pavlik

Chan²,

Hyman³

et al. 2015

CHYR

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Objectives African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP. Three of the groups performed a pooled analysis of trial results to determine: 1) the magnitude of the combined intervention effect; and 2) how the pooled results could inform the methodology for future health-system level BP interventions. Methods Using a cluster randomized design, the trials enrolled AAs with uncontrolled hypertension to test interventions targeting a combination of patient and clinician behaviors. The 12-month Systolic BP (SBP) and Diastolic BP (DBP) effects of intervention or control cluster assignment were assessed using mixed effects longitudinal regression modeling. Results 2,015 patients representing 352 clusters participated across the three trials. Pooled BP slopes followed a quadratic pattern, with an initial decline, followed by a rise toward baseline, and did not differ significantly between intervention and control clusters: SBP linear coefficient = −2.60±0.21 mmHg per month, p<0.001; quadratic coefficient = 0.167± 0.02 mmHg/month, p<0.001; group by time interaction group by time group x linear time coefficient=0.145 ± 0.293, p=0.622; group x quadratic time coefficient= −0.017 ± 0.026, p=0.525). Results were similar for DBP. The individual sites did not have significant intervention effects when analyzed separately. Conclusion Investigators planning behavioral trials to improve BP control in health systems serving AAs should plan for small effect sizes and employ a “run-in” period in which BP can be expected to improve in both experimental and control clusters.

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Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions

Cited by 37 publications

References 26 publications

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial

Designing and Evaluating Health Systems Level Hypertension Control Interventions for African-Americans: Lessons from a Pooled Analysis of Three Cluster Randomized Trials

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