Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?

Abstract

Background

Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after completion of a hypertension self-management trial.

Methods and results

This study is a follow-up analysis of an 18-month, 4-arm, hypertension self-management trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 interventions. Clinic-derived systolic blood pressure obtained before, during, and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures, and total expenditures were estimated using generalized estimating equations. The 3 telephone-based interventions were nurse-administered health behavior promotion, provider-administered medication adjustments based on hypertension treatment guidelines, or a combination of both. Intervention calls were triggered by home BP values transmitted via telemonitoring devices. Clinical and economic outcomes were examined 12 months before, 18 months during, and 18 months after trial completion. Compared with usual care, patients randomized to the combined arm had greater improvement in proportion of BP control during and after the 18-month trial and estimated proportion of BP control improved 18 months after trial completion for patients in the behavioral and medication management arms. Among the patients with inadequate baseline BP control, estimated mean systolic BP was significantly lower in the combined arm as compared with usual care during and after the 18-month trial. Utilization and expenditure trends were similar for patients in all 4 arms.

Conclusions

Behavioral and medication management can generate systolic BP improvements that are sustained 18 months after trial completion.

Clinical trial registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00237692.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1161/circoutcomes.113.000309

Publication Info

Maciejewski, Matthew L, Hayden B Bosworth, Maren K Olsen, Valerie A Smith, David Edelman, Benjamin J Powers, Miriam A Kaufman, Eugene Z Oddone, et al. (2014). Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?. Circulation. Cardiovascular quality and outcomes, 7(2). pp. 269–275. 10.1161/circoutcomes.113.000309 Retrieved from https://hdl.handle.net/10161/30017.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Maciejewski

Matthew Leonard Maciejewski

Professor in Population Health Sciences

Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences. He is also a Senior Research Career Scientist and Director of the Non-randomized Design Lab in the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Medical Center. Matt also holds Adjunct Professor appointments in the Schools of Public Health and Pharmacy at the University of North Carolina at Chapel Hill.

He has received funding from NIDDK, NIDA, CMS, AHRQ, VA HSR&D, and the RWJ Foundation to conduct evaluation of long-term clinical and economic outcomes of surgical interventions, behavioral interventions and Medicare program/policy changes on patients with obesity or cardiometabolic conditions.  He is also interested in methods for addressing unobserved confounding in observational studies.  Matt evaluated the first-ever population-based implementation of value-based insurance design and led the first-ever linkage of lab results and Medicare FFS claims.  He has published over 250 papers in peer-reviewed journals such as JAMA, JAMA Internal Medicine, JAMA Surgery, Annals of Internal Medicine, Health Economics, Medical Care, Health Services Research, Journal of Clinical Epidemiology and Diabetes Care.

Areas of expertise: Health Services Research, Health Economics, Health Policy, Multimorbidity

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Olsen

Maren Karine Olsen

Professor of Biostatistics & Bioinformatics

Health services research, longitudinal data methods, missing data methods


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