Controlling Hypertension Outcomes by Improved Communication & Engagement
Condition: Hypertension; Stroke
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      This randomized control study tested the feasibility of two communication enhancement
      interventions: one with veterans who had a stroke and demonstrated poorly controlled
      hypertension; the other with VA primary care providers who provided routine outpatient
      medical care to these veterans. This study intervened with both members of the
      provider-patient dyad in an attempt to improve the self-management of hypertension by
      improving communication during visits to the VA outpatient clinic, specifically by enabling
      veterans to communicate their questions and concerns about chronic disease self-management to
      their providers more effectively, and to help providers improve their ability to communicate
      more effectively with this population of veterans.
    

Detailed description: 
      The communication intervention had two goals; (a) coaching to enhance veteran's abilities to
      communicate their questions and concerns about self-management for hypertension to their
      physician; and (b) improving provider's communication skills for enhancing and encouraging
      self-management of hypertension.

      A health educator met with each participating veteran in the intervention arm prior to the
      2nd visit to develop a plan for enhancing communication about self-management of
      hypertension.

      The PI provided the Four Habits communication training to the 5 primary care providers in the
      intervention arm. Two clinic visits between each participating provider-patient pair were
      videotaped and coded.

      This project had a goal of enrolling 10 VA primary care providers to participate in the
      randomized control trial and 30 veterans (3 veterans from the panel of each of the 10
      participating providers) who had a stroke and now demonstrated poorly controlled
      hypertension. The study evaluated the difference between the two groups, and compared the
      content of the provider-patient conversations around hypertension management.
    

Intervention name(s): Informational Guide for Patients; Video-Assisted Coaching; Monograph for Physicians; Educational Coaching; Control
Intervention type(s): Other; Behavioral; Other; Behavioral; Other
Intervention description(s): Veterans received a copy of the NIA guide for "Talking with Your Doctor". This pamphlet was specifically developed for this purpose (updated in 2002). It has pictorials and is written at an 8th grade level.; Physicians participated in an audiotaped intensive 30 minute, one-on-one educational intervention with PI Frankel after their first set of visits from their three participating patients, but before seeing them for follow-ups. The main goal of this video-assisted coaching session was to review and discuss the analysis of the physician's videotaped visits using the Four Habits framework, with a particular focus on improving communication about self-management.; Primary care providers randomly assigned to the "Intervention-Physicians" arm of this study received a copy of the Four Habits of Highly Effective Physicians. The Four Habits provided practical evidence-based advice for improving patient-physician communication.; an educator met with each Veteran in the intervention arm individually for 20-30 minutes to review the material in the pamphlet and develop a plan for enhancing communication about self-management of hypertension with their doctor [Coaching]. To facilitate communication change, the educator assisted the patient in setting a goal to achieve during their visit. The educator also provided telephone follow-up within 24 hours to review satisfaction and effectiveness of the visit and assess barriers and facilitators to communicating about self-management.; The primary care providers randomly assigned to the "Control-Physicians" arm did not receive any additional coaching or resources and conducted their practice as usual.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: hypertension; physician-patient relations; communication