A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients

Lisa A. Cooper, Debra L. Roter, Kathryn A. Carson, Lee R. Bone, Susan M. Larson, Edgar R. Miller, Michael S. Barr, David M. Levine

Research output: Contribution to journalArticlepeer-review

114 Scopus citations

Abstract

BACKGROUND: African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations. OBJECTIVE: To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups. DESIGN: Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland. PARTICIPANTS: Forty-one primary care physicians and 279 hypertension patients. INTERVENTIONS: Physician communication skills training and patient coaching by community health workers. MAIN MEASURES: Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control. KEY RESULTS: Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p=0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β=+6.20 vs. -5.24, p=0.03) and PIC dimensions related to doctor facilitation (β=+0.22 vs. -0.17, p=0.03) and information exchange (β=+0.32 vs. -0.22, p=0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg). CONCLUSION: Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.

Original languageEnglish (US)
Pages (from-to)1297-1304
Number of pages8
JournalJournal of general internal medicine
Volume26
Issue number11
DOIs
StatePublished - Nov 2011

Keywords

  • hypertension
  • patient-centered care
  • patient-physician communication

ASJC Scopus subject areas

  • Internal Medicine

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