Clinical trial NCT00682968: Evidence Synthesis: Hypertension Medication Adherence & Intensification
Official title: Evidence Synthesis: Hypertension Medication Adherence & Intensification
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hypertension
Keywords: patient non-adherence
antihypertensive agents
hypertension
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2008-05-23
Enrollment: 20
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: OTHER
Sampling method: NON_PROBABILITY_SAMPLE
Study population: VA clinicians, hospital administrators and PIs/authors of above studies

Brief summary: Hypertension affects nearly 50 million Americans \[1\] and is the most common chronic condition among veterans. Unfortunately, many patients with established hypertension have poorly controlled blood pressure (BP); control rates in the VA are at approximately 70% currently. While clinician failure to aggressively manage hypertension through therapeutic intensification (clinical inertia, or failure to intensify pharmacotherapy appropriately) contributes to poor blood pressure control, even when doctors do intensify therapy, 43-78% of patients fail to adhere to recommended therapies, indicating that adherence remains a central problem in hypertension care. This suggests important opportunities for interventions to improve risk factor control by working through clinicians, their teams, or their delivery systems, as well as with patients, to address both patient adherence and clinical inertia.

Detailed description: Background:

Hypertension affects nearly 50 million Americans \[1\] and is the most common chronic condition among veterans. Unfortunately, many patients with established hypertension have poorly controlled blood pressure (BP); control rates in the VA are at approximately 70% currently. While clinician failure to aggressively manage hypertension through therapeutic intensification (clinical inertia, or failure to intensify pharmacotherapy appropriately) contributes to poor blood pressure control, even when doctors do intensify therapy, 43-78% of patients fail to adhere to recommended therapies, indicating that adherence remains a central problem in hypertension care. This suggests important opportunities for interventions to improve risk factor control by working through clinicians, their teams, or their delivery systems, as well as with patients, to address both patient adherence and clinical inertia.

Objectives:

Recognizing the importance of understanding and intervening to improve adherence to antihypertensive medications and to address clinical inertia, VA HSR\&D has funded numerous studies in the last decade to address these issues, either through interventions or through exploratory studies to better understand the problems. There has been little discussion among investigators and clinical managers as to the comparative effectiveness of such approaches -- which practices are 'best' for use in VA, based on the evidence emerging from these studies. Thus, we conducted an evidence synthesis project to accomplish these aims, in order to summarize the literature and facilitate exchange among investigators and clinicians on the implications of this growing body of VA research.

Methods:

We sought to catalog and extensively describe all VA funded studies conducted over the past decade focusing on adherence to antihypertensive medications, therapeutic intensification, or both. We also included non-VA funded studies focused on the care of veterans receiving health care in VA. We aimed to describe gaps in current research and identify important areas for future research, synthesize results from the studies, whether published or unpublished, in the form of an evidence synthesis, and to build on these efforts to develop more formal exchange and collaboration among VA researchers and clinicians working on addressing these important issues.

Status:

Complete.

Eligibility criteria: Inclusion Criteria:

* Studies funded by VA from 1998 to the present looking at hypertension medication adherence and physician adherence to hypertension guidelines

Exclusion Criteria:

* N/A

Primary outcomes:
measure: Medication adherence, physician guideline adherence
timeFrame: varies
Secondary outcomes:
Other outcomes:
Locations:
city: Boston
country: United States
facility: VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
state: Massachusetts
Study officials:
affiliation: VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
name: Nancy R. Kressin, PhD
role: PRINCIPAL_INVESTIGATOR
References: