Please use this identifier to cite or link to this item: https://doi.org/10.1186/1745-6215-10-13
Title: Hypertension Improvement Project (HIP): Study protocol and implementation challenges
Authors: Dolor, R.J
Yancy Jr
Owen, W.F
Matchar, D.B 
Samsa, G.P
Pollak, K.I 
Lin, P.-H
Ard, J.D
Prempeh, M
McGuire, H.L
Batch, B.C
Fan, W
Svetkey, L.P
Keywords: adult
article
behavior therapy
blood pressure regulation
clinical protocol
clinical trial
controlled clinical trial
controlled study
cost benefit analysis
diastolic blood pressure
female
health program
human
hypertension
intervention study
lifestyle modification
major clinical study
male
medical practice
outcome assessment
randomized controlled trial
systolic blood pressure
treatment response
attitude to health
blood pressure
chronic disease
clinical competence
clinical practice
clinical protocol
diet
economics
exercise
health personnel attitude
methodology
multimodality cancer therapy
pathophysiology
patient compliance
patient education
practice guideline
psychological aspect
risk reduction
time
treatment outcome
antihypertensive agent
Antihypertensive Agents
Attitude of Health Personnel
Blood Pressure
Chronic Disease
Clinical Competence
Clinical Protocols
Combined Modality Therapy
Cost-Benefit Analysis
Diet
Exercise
Guideline Adherence
Health Knowledge, Attitudes, Practice
Humans
Hypertension
Patient Compliance
Patient Education as Topic
Physician's Practice Patterns
Practice Guidelines as Topic
Research Design
Risk Reduction Behavior
Time Factors
Treatment Outcome
Issue Date: 2009
Publisher: BMC
Citation: Dolor, R.J, Yancy Jr, Owen, W.F, Matchar, D.B, Samsa, G.P, Pollak, K.I, Lin, P.-H, Ard, J.D, Prempeh, M, McGuire, H.L, Batch, B.C, Fan, W, Svetkey, L.P (2009). Hypertension Improvement Project (HIP): Study protocol and implementation challenges. Trials 10 : 13. ScholarBank@NUS Repository. https://doi.org/10.1186/1745-6215-10-13
Rights: Attribution 4.0 International
Abstract: Background: Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care. Methods and design: This paper describes the protocol of a nested 2 × 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months. Discussion: Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources. © 2009 Dolor et al; licensee BioMed Central Ltd.
Source Title: Trials
URI: https://scholarbank.nus.edu.sg/handle/10635/178227
ISSN: 1745-6215
DOI: 10.1186/1745-6215-10-13
Rights: Attribution 4.0 International
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