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Translational Behavioral Medicine
Published in: Translational Behavioral Medicine 1/2011

01-03-2011

Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid

Authors: Hayden B Bosworth, PhD, C Annette DuBard, MD, MPH, Jill Ruppenkamp, MS, Troy Trygstad, PharmD, PhD, Denis Levis Hewson, RN, BSN, MSPH, George L Jackson, PhD, MHA

Published in: Translational Behavioral Medicine | Issue 1/2011

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Abstract

Elevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients. Patients had at least one phone call by care managers. The individually tailored program focused on improving lifestyle and medication adherence. The primary outcome was the medication possession ratio (MPR), calculated using fill history from pharmacy claims. We observed an improvement of medication possession from 55% 9–12 months prior to program enrollment to 77% 9–12 months post initiation of the program. We demonstrated 12 month sustainability and increased MPR. Personal interaction by phone allows the intervention to be tailored to participants’ current concerns, health goals, and specific barriers to achieving these goals.
Literature
1.
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama, 289(19), 2560–2571.PubMedCrossRef
2.
Hyman, D. J., & Pavlik, V. N. (2002). Poor hypertension control: let’s stop blaming the patients. Cleveland Clinic Journal of Medicine, 69(10), 793–799.PubMedCrossRef
3.
Egan, B. M., Zhao, Y., & Axon, R. N. (2010). US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. Jama, 303(20), 2043–2050.PubMedCrossRef
4.
Schroeder, K., Fahey, T., & Ebrahim, S. (2004). Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database of Systematic Reviews, (2), CD004804.
5.
Thorpe, C. T., Bryson, C. L., Maciejewski, M. L., & Bosworth, H. B. (2009). Medication acquisition and self-reported adherence in veterans with hypertension. Medical Care, 47(4), 474–481.PubMedCrossRef
6.
Bosworth, H. B., Dudley, T., Olsen, M. K., Voils, C. I., Powers, B., Goldstein, M. K., et al. (2006). Racial differences in blood pressure control: potential explanatory factors. American Journal of Medicine, 119(1), 70.PubMedCrossRef
7.
Bosworth, H. B., & Oddone, E. Z. (2002). A model of psychosocial and cultural antecedents of blood pressure control. Journal of the National Medical Association, 94(4), 236–248.PubMed
8.
Bosworth, H. B., & Voils, C. (2006). Theoretical models to understand adherence. In H. Bosworth, E. Oddone, & M. Weinberger (Eds.), Patient treatment adherence: concepts, interventions, and measurement. Mahwah: Lawrence Erlbaum Associates.
9.
Grol, R. (2005). Implementation of changes in practice. In H. J Ce Harrison H, Jackson C (Eds.), Improving patient care the implementation of change in clinical practice (pp. 6–14). Edinburgh: Elsevier Butterworth Heinemann.
10.
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients' care. Lancet, 362(9391), 1225–1230.PubMedCrossRef
11.
Kronick, R., Bella, M., Gilmer, T., & Somers, S. (2007). The faces of Medicaid II: recognizing the care needs of people with multiple chronic conditions Washington: Center for Health Care Strategies.
12.
Committee on Comparative Effectiveness Research Prioritization, Institute of Medicine. (2009). Initial national priorities for comparative effectiveness research. Washington: The National Academies Press.
13.
Bosworth, H. B., Olsen, M. K., Dudley, T., Orr, M., Goldstein, M. K., Datta, S. K., et al. (2009). Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial. American Heart Journal, 157(3), 450–456.PubMedCrossRef
14.
Bosworth, H. B., Olsen, M. K., Grubber, J. M., Neary, A. M., Orr, M. M., Powers, B. J., et al. (2009). Two self-management interventions to improve hypertension control: a randomized trial. Annals of Internal Medicine, 151(10), 687–695.PubMed
15.
Steiner, B. D., Denham, A. C., Ashkin, E., Newton, W. P., Wroth, T., & Dobson, L. A., Jr. (2008). Community care of North Carolina: improving care through community health networks. Annals of Family Medicine, 6(4), 361–367.PubMedCrossRef
16.
Dobson, L. A., Jr., & Hewson, D. L. (2009). Community care of North Carolina—an enhanced medical home model. North Carolina Medical Journal, 70(3), 219–224.PubMed
17.
DuBard, C. A., & Cockerham, J. (2008). Community Care of North Carolina and the medical home approach to chronic kidney disease. North Carolina Medical Journal, 69(3), 229–232.PubMed
18.
Wagner, E. H. (1998). Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice, 1(1), 2–4.PubMed
19.
Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009). Evidence on the chronic care model in the new millennium. Health Affairs (Millwood), 28(1), 75–85.CrossRef
20.
DuBard, C. A. (2009). Moving forward with the medical home: evidence, expectations, and insights from CCNC. North Carolina Medical Journal, 70(3), 225–230.PubMed
21.
Woolf, B. (1992). Customer specific marketing. New York: Rand McNally.
22.
Bosworth, H. B., Olsen, M. K., Dudley, T., Orr, M., Neary, A., Harrelson, M., et al. (2007). The take control of your blood pressure (TCYB) study: study design and methodology. Contemporary Clinical Trials, 28(1), 33–47.PubMedCrossRef
23.
Karanja, N., Obarzanek, E., Lin, P. H., McCullough, M. L., Phillips, K. M., Swain, J. F., et al. (1999). Descriptive characteristics of the dietary patterns used in the dietary approaches to stop hypertension trial. DASH Collaborative Research Group. Journal of the American Dietetic Association, 99, S19–S27.PubMedCrossRef
24.
Sacks, F. M., Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., et al. (1999). A dietary approach to prevent hypertension: a review of the dietary approaches to stop hypertension (DASH) study. Clinical Cardiology, 22(7 Suppl), III6–III10.PubMed
25.
Svetkey, L., Sacks, F. M., Obarzanek, E., for the DASH-Sodium Collaborative Research Group, et al. (1999). The DASH diet, sodium intake and blood pressure trial (DASH-sodium): rationale and design. Journal of the American Dietetic Association, 99, S96–S104.PubMedCrossRef
26.
Svetkey, L., Simons-Morton, D., Vollmer, W. M., Appel, L. J., Conlin, P. R., Ryan, D. H., et al. (1999). Effects of dietary patterns on blood pressure: subgroup analysis of the dietary approaches to stop hypertension (DASH) randomized clinical trial. Archives of Internal Medicine, 159(3), 285–293.PubMedCrossRef
27.
Neter, J. E., Stam, B. E., Kok, F. J., Grobbee, D. E., & Geleijnse, J. M. (2003). Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension, 42(5), 878–884.PubMedCrossRef
28.
The Trials of Hypertension Prevention Collaborative Research Group (1992). The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. Jama, 267(9), 1213–1220.
29.
Cutler, J. A. (1991). Randomized clinical trials of weight reduction in nonhypertensive persons. Annals of Epidemiology, 1(4), 363–370.PubMedCrossRef
30.
Kelley, G. A., & Kelley, K. S. (2000). Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension, 35(3), 838–843.PubMed
31.
Whelton, S. P., Chin, A., Xin, X., & He, J. (2002). Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Annals of Internal Medicine, 136(7), 493–503.PubMed
32.
Xin, X., He, J., Frontini, M. G., Ogden, L. G., Motsamai, O. I., & Whelton, P. K. (2001). Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension, 38(5), 1112–1117.PubMedCrossRef
33.
Bosworth HB, Olsen MK, Neary A, Orr M, Grubber J, Svetkey L, et al. (2007). Take control of your blood pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Education and Counseling, Dec 28.
34.
Kincaid J, Fishburne RP, Rogers RL, Chissom BS (1975). Derivation of new readability formulas (Automated Readability Index, Fog Count, and Flesch Reading Ease Formula) for Navy enlisted personnel research branch report 8–75. In: M. Tenn (Ed.), Chief of naval training.
35.
Eraker, S., Kirscht, J. P., & Becker, M. H. (1984). Understanding and improving patient compliance. Annals of Internal Medicine, 100, 258–268.PubMed
36.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.PubMedCrossRef
37.
Bosworth, H. B., Olsen, M. K., Gentry, P., Orr, M., Dudley, T., McCant, F., et al. (2005). Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention. Patient Education and Counseling, 57(1), 5–14.PubMedCrossRef
38.
DeBusk, R. F., West, J. A., Miller, N. H., & Taylor, C. B. (1999). Chronic disease management: treating the patient with disease(s) vs treating disease(s) in the patient. Archives of Internal Medicine, 159(22), 2739–2742.PubMedCrossRef
39.
DeBusk, R. F., Houston Miller, N., & West, J. A. (1999). Diabetes case management. Annals of internal medicine, 130(10), 863.PubMed
40.
Smith, P. M., Kraemer, H. C., Miller, N. H., DeBusk, R. F., & Taylor, C. B. (1999). In-hospital smoking cessation programs: who responds, who doesn’t? Journal of Consulting and Clinical Psychology, 67(1), 19–27.PubMedCrossRef
41.
DeBusk, R. F., Miller, N. H., Superko, H. R., Dennis, C. A., Thomas, R. J., Lew, H. T., et al. (1994). A case-management system for coronary risk factor modification after acute myocardial infarction. Annals of Internal Medicine, 120(9), 721–729.PubMed
42.
Friedman, R. H., Kazis, L. E., Jette, A., Smith, M. B., Stollerman, J., Torgerson, J., et al. (1996). A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. American Journal of Hypertension, 9(4 Pt 1), 285–292.PubMedCrossRef
43.
Pinto, B. M., Friedman, R., Marcus, B. H., Kelley, H., Tennstedt, S., & Gillman, M. W. (2002). Effects of a computer-based, telephone counseling system on physical activity. American Journal of Preventive Medicine, 23(2), 113–120.PubMedCrossRef
44.
Resnicow, K., Jackson, A., Wang, T., De, A. K., McCarty, F., Dudley, W. N., et al. (2001). A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the eat for life trial. American Journal of Public Health, 91(10), 1686–1693.PubMedCrossRef
45.
Friedman, R. H. (1998). Automated telephone conversations to assess health behavior and deliver behavioral interventions. Journal of Medical Systems, 22(2), 95–102.PubMedCrossRef
46.
Wasson, J., Gaudette, C., Whaley, F., Sauvigne, A., Baribeasu, P., & Welch, H. G. (1992). Telephone care as a substitute for routine clinic follow-up. Journal of the American Medical Association, 267, 1788–1793.PubMedCrossRef
47.
Weinberger, M., Tierney, W. M., Cowpar, P. A., Katz, B. P., & Booher, P. (1993). Cost-effectiveness of increased telephone contact for patients with osteoarthritis: a randomized controlled trial. Arthritis and Rheumatism, 26, 243–246.
48.
Bureau USC. (1999). Statistical abstracts of the United States, the national data book. Washington, DC
49.
Cutler, D. M., & Everett, W. (2010). Thinking outside the pillbox—medication adherence as a priority for health care reform. New England Journal of Medicine, 362(17), 1553–1555.PubMedCrossRef
50.
Rozenfeld, Y., Hunt, J. S., Plauschinat, C., & Wong, K. S. (2008). Oral antidiabetic medication adherence and glycemic control in managed care. American Journal of Managed Care, 14(2), 71–75.PubMed
51.
Pittman, D. G., Tao, Z., Chen, W., & Stettin, G. D. (2010). Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am J Manag Care, 16(8), 568–576.PubMed
52.
Peterson, A. M., Nau, D. P., Cramer, J. A., Benner, J., Gwadry-Sridhar, F., & Nichol, M. (2007). A checklist for medication compliance and persistence studies using retrospective databases. Value Health, 10(1), 3–12.PubMedCrossRef
53.
Andrade, S. E., Kahler, K. H., Frech, F., & Chan, K. A. (2006). Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiology and Drug Safety, 15(8), 565–574. discussion 75-7.PubMedCrossRef
54.
Powers, B., King, J. L., Ali, R., Alkon, A., Bowlby, L., Edelman, D., et al. (2009). The cholesterol, hypertension, and glucose education (CHANGE) study for African-Americans with diabetes: study design and methodology. American Heart Journal, 158(3), 342–348.PubMedCrossRef
55.
Bosworth, H. B., Olsen, M. K., McCant, F., Harrelson, M., Gentry, P., Rose, C., et al. (2007). Hypertension intervention nurse telemedicine study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. American Heart Journal, 153(6), 918–924.PubMedCrossRef
56.
Dunbar-Jacob, J., Burkem, L. E., & Pucyynski, S. (Eds.). (1995). Clinical assessment and management of adherence to medical regimens. Washington: American Psychological Association.
57.
Bosworth, H. B. (2005). Medication adherence. In H. B. Bosworth, E. Z. Oddone, & M. Weinberger (Eds.), Patient treatment adherence: concepts, interventions, and measurement. Mahwah: Lawrence Erlbaum Associates.
58.
Esposti, L. D., Di Martino, M., Saragoni, S., Sgreccia, A., Capone, A., Buda, S., et al. (2004). Pharmacoeconomics of antihypertensive drug treatment: an analysis of how long patients remain on various antihypertensive therapies. Journal of Clinical Hypertension (Greenwich), 6(2), 76–84.CrossRef
59.
Degli Esposti, L., Degli Esposti, E., Valpiani, G., Di Martino, M., Saragoni, S., Buda, S., et al. (2002). A retrospective, population-based analysis of persistence with antihypertensive drug therapy in primary care practice in Italy. Clinical Therapeutics, 24(8), 1347–1357. discussion 6.PubMedCrossRef
60.
Juncos, L. (1990). Patient compliance and angiotension converting enzyme inhibitors in hypertension. Journal of Cardiovascular Pharmacology, 15, S22–S25.PubMedCrossRef
61.
Degli Esposti, E., Sturani, A., Di Martino, M., Falasca, P., Novi, M. V., Baio, G., et al. (2002). Long-term persistence with antihypertensive drugs in new patients. Journal of Human Hypertension, 6, 439–444.CrossRef
62.
Clark, L. (1991). Improving compliance and increasing control of hypertension needs of special hypertensive populations. American Heart Journal, 121, 664–669.PubMedCrossRef
63.
Dunbar-Jacob, J., Dwyer, K., & Dunning, E. J. (1991). Compliance with antihypertensive regimen: a review of the research in the 1980 s. Annals of Behavioral Medicine, 13(1), 31–39.
64.
Luscher, T., & Vetter, W. (1990). Adherence to medication. Journal of Human Hypertension, 4(Suppl 1), 43–46.PubMed
65.
Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P., & Yao, X. (2008). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, (2), CD000011.
66.
Reed, S. D., Li, Y., Oddone, E. Z., Neary, A. M., Orr, M. M., Grubber, J. M., et al. (2010). Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension. American Journal of Hypertension, 23(2), 142–148.PubMedCrossRef
67.
Burnier, M., Schneider, M. P., Chiolero, A., Stubi, C. L., & Brunner, H. R. (2001). Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. Journal of Hypertension, 19(2), 335–341.PubMedCrossRef
68.
Wetzels, G. E., Nelemans, P. J., Schouten, J. S., Dirksen, C. D., van der Weijden, T., Stoffers, H. E., et al. (2007). Electronic monitoring of adherence as a tool to improve blood pressure control. A randomized controlled trial. American Journal of Hypertension, 20(2), 119–125.PubMedCrossRef
69.
Datta, S. K., Oddone, O. E., Olsen, M. K., Orr, M., McCant, F., Gentry, P., et al. (2010). Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. American Heart Journal, 160(2), 257–263.PubMedCrossRef
70.
Bramley, T. J., Gerbino, P. P., Nightengale, B. S., & Frech-Tamas, F. (2006). Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. Journal of Managed Care Pharmacy, 12(3), 239–245.PubMed
Metadata
Title
Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid
Authors
Hayden B Bosworth, PhD
C Annette DuBard, MD, MPH
Jill Ruppenkamp, MS
Troy Trygstad, PharmD, PhD
Denis Levis Hewson, RN, BSN, MSPH
George L Jackson, PhD, MHA
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Translational Behavioral Medicine / Issue 1/2011
Print ISSN: 1869-6716
Electronic ISSN: 1613-9860
DOI
https://doi.org/10.1007/s13142-010-0007-x

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