Implementing Evidence Based Treatment of Hypertension

Completed

Phase N/A Results

Trial Description

This study examines the use of patient initiated discussions of blood pressure medication in the primary care setting. Additionally, this study examines different levels of patient incentive(s) to initiate discussions with providers including information only, information plus 20$ incentive and reimbursement for 6 months of copay, and information/monetary incentive plus a reminder call prior to the index visit. Patient opinions about doctor/patient relationships will be assessed. Provider attitudes and prescribing behaviors will be analyzed as well.

Detailed Description

Patients will be randomized to Pure control, intervention control, intervention group a, intervention group b or intervention group c. Pure control patients will not receive any study information about diuretics and their providers will not see any patients who receive our study intervention letter. Patients in the intervention control group will not receive the intervention but will see providers who have other patients in the intervention groups. Patients in intervention group a will receive a customized letter prior to their next primary care appointment with information regarding the patient's specific blood pressure, current blood pressure medication and recommendation for switching or adding a thiazide. Patients in group b will receive the customized intervention letter as well as a 20$ incentive for discussing the information with their provider and a copay reimbursement for 6 months if a prescription is written for a thiazide. Patients in group c will receive the intervention letter, 20$ discussion incentive, copay reimbursement as well as a phone call reminder 1-2 days prior to their primary care visit.

Conditions

Interventions

  • Patient Education and Follow-up Other
    Intervention Desc: Hypertension treatment discussion, customized letter, financial incentive and health educator phone call.
  • Patient education to engage provider in hypertension treatment discussion Behavioral
    Intervention Desc: Patients will receive a customized/tailored letter including most recent clinic blood pressure, current blood pressure medications and suggested htn medication(s)
    ARM 1: Kind: Experimental
    Label: 1
    Description: Patient Intervention arms: pure control (no intervention letter); intervention control (patient does not receive intervention letter, but provider sees other patients who may bring in letter); group a (intervention letter only); group b (intervention, + 20$ incentive for discussion w/ provider and 6 month copay reimbursement); group c (intervention letter, 20$ incentive for discussion w/ provider + copay reimbursement, plus reminder phone call 1-3 days prior to primary care visit)
    ARM 2: Kind: Experimental
    Label: Arm 1
    Description: Patient Intervention arms: pure control (no intervention letter); intervention control (patient does not receive intervention letter, but provider sees other patients who may bring in letter); group a (intervention letter only); group b (intervention, + 20$ incentive for discussion w/ provider and 6 month copay reimbursement); group c (intervention letter, 20$ incentive for discussion w/ provider + copay reimbursement, plus reminder phone call 1-3 days prior to primary care visit)
  • Financial incentive and health educator phone call Behavioral
    Intervention Desc: Patients may receive 20$ for discussing the intervention letter with their provider and 6 months copay reimbursement and/or the 20$ discussion incentive, 6 months copay reimbursement as well as a phone call reminder 1-2 days prior to their primary care appt.
    ARM 1: Kind: Experimental
    Label: 1
    Description: Patient Intervention arms: pure control (no intervention letter); intervention control (patient does not receive intervention letter, but provider sees other patients who may bring in letter); group a (intervention letter only); group b (intervention, + 20$ incentive for discussion w/ provider and 6 month copay reimbursement); group c (intervention letter, 20$ incentive for discussion w/ provider + copay reimbursement, plus reminder phone call 1-3 days prior to primary care visit)
    ARM 2: Kind: Experimental
    Label: Arm 1
    Description: Patient Intervention arms: pure control (no intervention letter); intervention control (patient does not receive intervention letter, but provider sees other patients who may bring in letter); group a (intervention letter only); group b (intervention, + 20$ incentive for discussion w/ provider and 6 month copay reimbursement); group c (intervention letter, 20$ incentive for discussion w/ provider + copay reimbursement, plus reminder phone call 1-3 days prior to primary care visit)

Trial Design

  • Allocation: Randomized
  • Masking: Open Label
  • Endpoint: Efficacy Study
  • Intervention: Factorial Assignment

Patient Involvement

Patients will be randomized to Pure control, intervention control, intervention group a, intervention group b or intervention group c. Pure control patients will not receive any study information about diuretics and their providers will not see any patients who receive our study intervention letter. Patients in the intervention control group will not receive the intervention but will see providers who have other patients in the intervention groups. Patients in intervention group a will receive a customized letter prior to their next primary care appointment with information regarding the patient's specific blood pressure, current blood pressure medication and recommendation for switching or adding a thiazide. Patients in group b will receive the customized intervention letter as well as a 20$ incentive for discussing the information with their provider and a copay reimbursement for 6 months if a prescription is written for a thiazide. Patients in group c will receive the intervention letter, 20$ discussion incentive, copay reimbursement as well as a phone call reminder 1-2 days prior to their primary care visit.

Outcomes

Type Measure Time Frame Safety Issue
Primary The percent of patients taking thiazide diuretics at their index visit and at 6 and 12 months; The percent of patients at blood pressure treatment goal at 6 and 12 months; and Mean blood pressure at 6 and 12 months
Secondary % of Pt's who started talks with their providers about meds at the 1st visit, $ & # of anti-HTN meds, AE's, HTN med compliance, O/P lab tests used during primary care visits, # of visits to clinics & ER's, PT knowledge of their blood pressure meds.
Secondary % of Patients who talked to their providers about meds at the 1st visit, $ & # of anti-HTN meds, AE's, HTN med compliance, O/P lab tests used during primary care visits, # of visits to clinics & ER's, PT knowledge of their blood pressure meds. 1-3 months after enrollment, at first opportunity for a regularly scheduled primary care visit. No

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