Nancy R Kressin1,2, A Rani Elwy1,3, Mark Glickman1,4, Michelle B Orner1, Gemmae M Fix1,5, Ann M Borzecki1,2,5, Lois A Katz6,7, Dharma E Cortés8,9, Ellen S Cohn10, Anna Barker1, Barbara G Bokhour1,5. 1. Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA. 2. Section of General Internal Medicine, Boston University School of Medicine; Boston, MA. 3. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University; Providence, RI. 4. Department of Statistics, Harvard University; Boston, MA. 5. Boston University School of Public Health; Boston, MA. 6. VA New York Harbor Healthcare System; New, York, NY. 7. New York University School of Medicine; New York, NY. 8. Cambridge Health Alliance; Cambridge, MA. 9. Harvard Medical School; Cambridge, MA. 10. Boston University, Sargent College of Health and Rehabilitation Sciences; Boston, MA.
Abstract
Objective: Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence. Methods: We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments. Results: Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control. Practical Implications: Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.
Objective: Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence. Methods: We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments. Results: Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control. Practical Implications: Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.
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