Clinician Counseling and Cultural Competency to Improve Hypertension Control and Therapy Adherence
Condition: Cardiovascular Diseases; Heart Diseases; Hypertension
MeSH terms: Hypertension; Cardiovascular Diseases; Heart Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to test the effect of clinician counseling and cultural
      competence training on medication compliance and blood pressure (BP) control in patients with
      high BP.
    

Detailed description: 
      BACKGROUND:

      Hypertension affects nearly 50 million people in the U.S. and is related to increased medical
      morbidity and mortality associated with a range of medical disorders. Despite the
      availability of effective treatments for BP control, less than 25 percent of patients with
      hypertension demonstrate such control, and researchers have found this to be related to
      important patient factors associated with pharmacotherapy adherence. Further, research has
      demonstrated that this adherence problem is greater among African Americans than among
      Caucasians. The focus of the study is on improvements in adherence among patients with
      hypertension. The study is most specifically targeted to reducing racial disparities in
      medication adherence by including an interventional element that specifically targets African
      American patients in its approach.

      DESIGN NARRATIVE:

      To improve patients' adherence with prescribed anti-hypertensive medication, BP control, and
      doctor-patient communication, and to decrease racial disparities in each area, the
      investigators will conduct a three-armed randomized controlled study in the general internal
      medicine clinics of a large urban teaching hospital serving many poor African American and
      white patients. Proven intervention strategies will be implemented by teaching clinicians to
      use patient-centered counseling, enhancing skills that are known to help patients change
      health-related behaviors, and enhancing cultural competency among clinicians, thereby further
      improving clinician-patient communication. One group of clinicians will implement only the
      patient-centered counseling program. A second group will implement the patient-centered
      counseling education program, augmenting it with an established method for cultural
      competency training. A third group (control group) will provide usual care. To assess
      outcomes, the study will evaluate pre-intervention patient adherence to prescribed
      medications through patient self-report and the use of electronic pill top monitoring,
      clinicians' provision of advice and counseling about anti-hypertensive medications and use of
      cultural competency skills, and the proportion of patients with controlled BP. Subsequent to
      the interventions, each of these outcomes will be assessed.

      The aims of this study are to: 1) improve patients' adherence to prescribed anti-hypertensive
      therapy; 1a. examine adherence rates at baseline, and examine whether there are racial
      differences in adherence; 1b. decrease racial disparities in patient adherence with
      anti-hypertensive therapy from the baseline to the follow-up assessments; and 1c. evaluate
      the relative efficacy of the patient-centered counseling intervention compared to
      patient-centered counseling augmented by cultural competency training on patients' medication
      adherence; 2) increase the proportion of patients with controlled hypertension; 2a. examine
      the baseline proportion of patients with controlled hypertension, and whether there are
      racial differences in rates of control; 2b. decrease racial disparities in the proportion of
      patients with controlled hypertension from the baseline to the follow-up assessments; and 2c.
      evaluate the relative efficacy of patient-centered counseling compared to patient-centered
      counseling augmented by cultural competency training on patients' BP control; and 3) improve
      clinicians' communication with patients regarding medication use, as measured by increased
      frequency of clinicians' provision of advice and counseling about anti-hypertensive
      medications and use of culturally competent communication styles; 3a. examine whether there
      are racial disparities in clinicians' provision of advice and counseling or culturally
      competent communication patterns about anti-hypertensive medications at baseline; 3b. examine
      whether the proposed interventions decrease any observed racial disparities in clinician
      communication over time; and 3c. evaluate the relative efficacy of the patient-centered
      counseling intervention compared to patient-centered counseling augmented by cultural
      competency training on clinicians' communication patterns.
    

Intervention name(s): Patient-centered Counseling
Intervention type(s): Behavioral
Intervention description(s): To improve patients' adherence with prescribed anti-hypertensive medication, improve blood pressure control and doctor-patient communication, we propose a three-armed randomized controlled trial in the internal medicine clinics of a large metropolitan teaching hospital which serves a large percentage of poor African American and white patients. We will implement an intervention strategy by teaching clinicians to counsel patients about hypertension control through the use of patient-centered counseling and by providing office-based support; critical to facilitating clinicians' use of this strategy. Through this intervention we will provide clinicians with communication skills that are proven to help patients change risk-related behaviors, and which will enhance doctor-patient communication.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research