Level of blood pressure above goal and clinical inertia in a Medicaid population

Viera, Anthony J.; Schmid, Dorothee; Bostrom, Susan; Yow, Angie; Lawrence, William Witherle; DuBard, C. Annette

doi:10.1016/j.jash.2010.07.003

Cited by 24 publications

(28 citation statements)

References 23 publications

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“…Although we are unaware of any previous investigation of factors associated with clinical inertia in a BP telemonitoring study, our findings are consistent with previously published reports of clinical inertia based on clinic BP measurements. 26,27 Ultimately, our study suggests that telemanagement interventions addressing clinical inertia may improve rates of treatment intensification in response to elevated home BP but not result in perfect intensification rates.…”

Section: Crowley Et Al Treatment Intensification In Bp Telemanagementmentioning

confidence: 83%

Treatment Intensification in a Hypertension Telemanagement Trial

et al. 2011

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Abstract-Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%).When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135. Previous studies provide evidence for improved BP control using telemanagement models in selected patient populations. [11][12][13] Compared with clinic BP measurement, home telemonitoring may also better predict cardiovascular risk and is less subject to observer bias (white-coat hypertension and masked hypertension). 14 -18 The Hypertension Intervention Nurse Telemedicine Study (HINTS) was an 18-month randomized, controlled trial designed to circumvent factors contributing to clinical inertia. 19 We examined data from the medication management arms of HINTS to determine how physicians reacted to elevated BP values, why they reacted as they did, and how their decisions impacted subsequent patient BP control after episodes of elevated BP. Our goal was to determine whether clinical inertia persisted in HINTS despite the efforts to overcome it. Methods HINTS DesignHINTS randomized 593 eligible veterans into 4 groups: (1) a nurse-administered behavioral management intervention; (2) a nurse-administered, physician-directed medication management intervention using a validated clinical decision support system; (3) a combined behavioral management and medication management intervention; and (4) usual care. Eligible patients received primary care at the Durham Veterans Affairs Medical Center, had a diagnosis of hypertension, used BP-lowering medication, and had inadequate BP control (Ͼ140/90 mm Hg for all patients) based on the average of the previous 12 months' clinic BP measurements obtained from electronic medical charts. Exclusion criteria were receipt of dialysis; a serum creatinine Ͼ2.5 or no documentation of renal function; history of organ transplant; hospitalization for stroke, myocardial infarction, or coronary artery revascularization within 3 months of contact; diagnosis of metastatic cancer or dementia; lack of a home telephone; residence in a nursing home; receipt of home health care; or severely impaired hearing ...

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Section: Crowley Et Al Treatment Intensification In Bp Telemanagementmentioning

confidence: 83%

Treatment Intensification in a Hypertension Telemanagement Trial

et al. 2011

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“…The results from this study, the first randomized, by guest on May 10, 2018 http://circ.ahajournals.org/ Downloaded from controlled trial of pharmacist prescribing, and prodigious evidence from 39 nonprescribing trials 11 support recent efforts to expand pharmacists' scope of practice to include medication management activities in an effort to address clinical inertia in hypertension management. [29][30][31] Acknowledgments Drs Tsuyuki and Houle had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We acknowledge the assistance of Dr Jeff Bakal with the statistical modeling.…”

Section: Downloaded Frommentioning

confidence: 99%

Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community

et al. 2015

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Background-Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. Methods and Results-We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). Conclusions-Pharmacist

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“…In the literature clinical inertia and patients' adherence to therapy seem the biggest challenges in optimizing the treatment of hypertension. 22,23 As we found that only about one-fifth reached the target blood pressure, it appears very unlikely that a change in patients' behaviour when participating in a study (Hawthorne effect) should have eliminated possible significant differences between the TBPM and the control group. At the time of inclusion, the mean number of antihypertensive drugs used per patient was only 0.7 indicating that the population was not a group of patients with resistant hypertension.…”

Section: Short-term Tbpm In Hypertensive Patients N Hoffmann-petersenmentioning

confidence: 79%

Short-term telemedical home blood pressure monitoring does not improve blood pressure in uncomplicated hypertensive patients

et al. 2016

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Telemonitoring of home blood pressure measurements (TBPM) is a new and promising supplement to diagnosis, control and treatment of hypertension. We wanted to compare the outcome of antihypertensive treatment based on TBPM and conventional monitoring of blood pressure. Participants were recruited from a prevalence study among citizens aged 55-64 years in the municipality of Holstebro, Denmark. The study was a randomized, controlled, unblinded 3 months' trial. In the intervention group, antihypertensive treatment was based on TBPM with transmission of the measurements and subsequent communication by telephone or e-mail. In the control group, patients received usual care. Primary outcome was reduction in daytime ambulatory blood pressure measurements (ABPM) from baseline to 3 months' follow-up. Of 375 participants randomized, primary outcome data were available for 356 (95%). In both groups, daytime ABPM decreased significantly. The decrease in daytime ABPM in the intervention group was systolic/diastolic, -8±12/-4±7 mm Hg. This did not differ significantly from the control group's -8±13/-4±8 mm Hg. An equal number of participants obtained normal daytime ABPM, in the intervention group 17% (31/175) versus control 21% (37/181), P=0.34. We found that both TBPM patients and controls achieved a significant blood pressure reduction in this randomized, controlled, unblinded 3-month trial. We found no difference in blood pressure reduction or number of patients reaching blood pressure goals. Further information and education of some general practitioners seem to be relevant regarding blood pressure management and control of hypertension.

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Level of blood pressure above goal and clinical inertia in a Medicaid population

Cited by 24 publications

References 23 publications

Treatment Intensification in a Hypertension Telemanagement Trial

Treatment Intensification in a Hypertension Telemanagement Trial

Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community

Short-term telemedical home blood pressure monitoring does not improve blood pressure in uncomplicated hypertensive patients

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