Evidence Synthesis: Hypertension Medication Adherence & Intensification
Information source: Department of Veterans Affairs
Information obtained from ClinicalTrials.gov on October 31, 2008
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Hypertension
Phase: N/A
Status: Not yet recruiting
Sponsored by: Department of Veterans Affairs Official(s) and/or principal investigator(s):
Nancy R. Kressin, PhD, Principal Investigator, Affiliation: VA Medical Center, Jamaica Plain Campus
Overall contact:
Nancy R Kressin, PhD, Phone: 781-687-2949, Email: nancy.kressin@va.gov
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.
Clinical Details
Official title: Evidence Synthesis: Hypertension Medication Adherence & Intensification
Study design: Other, Other
Primary outcome: Medication adherence, physician guideline adherence
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:
We propose an evidence synthesis project to better facilitate exchange among investigators
and clinicians on the implications of this growing body of VA research and to lay a solid
foundation for implementation and dissemination of effective strategies to address clinical
inertia and improve veterans adherence to antihypertensive medications, leading to improved
clinical outcomes. In addition, we aim to develop a network of collaboration and exchange
among VA researchers and clinicians addressing these issues. We intend for the processes
fostered through this grant to provide a model for enhancing VA-wide community.
Methods:
Our research team will first meet to review the studies initially identified and to determine
if any additional studies need to be added to the database. We will obtain information from
funded IIRs, SDPs, SDRs, CDAs and any other VA funding mechanisms we can identify. Next, the
team will determine the parameters on which each study will need to be characterized (e. g.
size of intervention effects, type of intervention). After abstracting the data, we will
begin the synthesis of study results. Based on this, we will identify gaps and draft a
document suggesting future research directions. Then, the team will conduct semi-structured
qualitative interviews with study investigators and VA clinical leaders to assess the
barriers and facilitators of each intervention identified. This information will be coded
and codified into a document listing the common barriers and facilitators for each type of
intervention, as well as a comprehensive list for all types of interventions. Finally, using
both the study results and the information from the interviews, we will develop a set of
recommendations for VA to use when considering implementation of future efforts to improve
antihypertensive medication adherence and medication intensification.
Status:
Start-up activities.
Eligibility
Minimum age: N/A.
Maximum age: N/A.
Gender(s): Both.
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
Locations and Contacts
Nancy R Kressin, PhD, Phone: 781-687-2949, Email: nancy.kressin@va.gov
VA Medical Center, Jamaica Plain Campus, Boston, Massachusetts 02130, United States
Additional Information
Starting date: July 2008
Ending date: September 2008
Last updated: May 22, 2008
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