The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

J of Clinical Hypertension

Bosworth

2014

Self Cite

Hypertension is a common and costly disease among US veterans. The Veterans Affairs (VA) healthcare system is the largest integrated healthcare provider in the United States and reviewing hypertension interventions developed in the VA may inform interventions delivered in other integrated healthcare systems. This review describes behavioral interventions to improve hypertension control that have been conducted in the VA since 1970. The authors identified 27 articles representing 15 behavioral interventional trials.Studies were heterogeneous across patients, providers, interventionist, and intervention components. The VA bridges services related to diagnosis, treatment, medication management, and behavioral counseling in a unified approach that supports collaboration and provides infrastructure for hypertension management. J Clin Hypertens (Greenwich). 2014;16:827-837. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.In recent decades there has been improvement in hypertension care provided in the Veterans Affairs (VA) healthcare system, the largest integrated healthcare provider in the United States. From 2000 to 2010, blood pressure (BP) control improved in the VA from 43.0% to 76.6%.1 There is a need for innovative behavioral approaches to continue and improve BP control. Reviewing hypertension interventions developed in the VA may inform interventions delivered in other systems. We performed a literature review describing behavioral hypertension interventions administered in the VA and distilled commonalities among successful programs. We emphasize behavioral management interventions because the success of BP control ultimately depends on a patient's willingness and ability to modify and maintain certain behaviors (eg, proper diet, exercise, and medication adherence). Therefore, our objective was not to report on VA hypertension care in general, but, rather, to focus on behavioral hypertension management interventions. METHODSA literature search using the PubMed database was conducted. We identified articles containing MeSH and key words addressing intervention studies or clinical trials, veterans, and hypertension. Articles were limited to those published in English in the past 44 years. Studies need not be solely conducted in the VA. This initial search yielded 171 articles. We screened full articles for eligibility. Exclusion criteria included: (1) commentary or editorial; (2) observational or retrospective analysis; (3) review article or solely described a conceptual mode; (4) not focused on hypertension; or (5) not a patient-focused behavioral hypertension intervention. The Figure outlines the article identification process. Interventions were divided into only behavioral or behavioral/medication management. We made this distinction because medication management interventions generally require complex design, necessitating the involvement and/or oversight of a clinician or pharmacist. RESULTSWe identified 27 articles representing 15 unique trials. Approximatel...

Section: Resultsmentioning

confidence: 99%

Behavioral Interventions to Improve Hypertension Control in the Veterans Affairs Healthcare System

J of Clinical Hypertension

Bosworth

2014

Self Cite

“…CITIES has been described in detail elsewhere. 15,16 In brief, CITIES was a tailored behavioral and educational pharmacist-administered and telephone-based intervention for reducing CVD risk. Patients were recruited from November 2011 until April 2014.…”

Section: ■■ Methods Data Sourcementioning

confidence: 99%

Patient-Reported Medication Adherence Barriers Among Patients with Cardiovascular Risk Factors

Stechuchak²,

Goldstein³

et al. 2015

JMCP

Self Cite

“…CITIES has been previously described (43, 44) . Briefly, this is a telephone-based, 12-month, clinical pharmacist-delivered medication and behavioral management intervention to reduce CVD risk for veterans with existing poorly controlled hypertension and/or hyperlipidemia.…”

Section: Methodsmentioning

confidence: 99%

Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease

Goldstein¹,

Stechuchak²,

Journal of Women's Health

et al. 2017

Self Cite

Background Compared to men, women have poorer lipid control. While potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated: 1) if satisfaction with lipid control and confidence in ability to improve it vary by gender; and 2) whether socio-demographic characteristics modify the association. Methods We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia. Results 428 Veterans (15% women) participated. Compared with men, women had higher LDL values at 141.2 mg/dL vs. 121.7 mg/dL respectively (p<0.05), higher health literacy, and were less likely to have someone to help track their medications (all p<0.05). In an adjusted model, women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1–10 Likert scale (p<0.05). There was no significant difference in confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 vs. 7.2 (p<0.05). Conclusions Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.