Nancy R Kressin1, Judith A Long2, Mark E Glickman3, Barbara G Bokhour3, Michelle B Orner4, Christine Clark5, James A Rothendler3, Dan R Berlowitz3. 1. Boston VA Healthcare System; Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Section of General Internal Medicine, Boston University School of Medicine; Health/care Disparities Research Program. 2. Center for Health Equity Research and Promotion, Philadelphia VAMC; Department of Internal Medicine, University of Pennsylvania School of Medicine. 3. Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Health Policy and Management Department, Boston University School of Public Health. 4. Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers. 5. Jesse Brown VAMC; University of Illinois at Chicago.
Abstract
BACKGROUND:Poor blood pressure (BP) control and racial disparities therein may be a function of clinical inertia and ineffective communication about BP care. METHODS: We compared two different interventions (electronic medical record reminder for BP care (Reminder only, [RO]), and clinician training on BP care-related communication skills plus the reminder (Reminder + Training, [R+T]) with usual care in three primary care clinics, examining BP outcomes among 8,866 patients, and provider-patient communication and medication adherence among a subsample of 793. RESULTS: Clinician counseling improved most at R+T. BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. CONCLUSIONS: More substantial or racial/ethnically tailored interventions are needed.
RCT Entities:
BACKGROUND: Poor blood pressure (BP) control and racial disparities therein may be a function of clinical inertia and ineffective communication about BP care. METHODS: We compared two different interventions (electronic medical record reminder for BP care (Reminder only, [RO]), and clinician training on BP care-related communication skills plus the reminder (Reminder + Training, [R+T]) with usual care in three primary care clinics, examining BP outcomes among 8,866 patients, and provider-patient communication and medication adherence among a subsample of 793. RESULTS: Clinician counseling improved most at R+T. BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. CONCLUSIONS: More substantial or racial/ethnically tailored interventions are needed.
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