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Effect of a patient activation intervention on hypertension medication optimization: results from a randomized
M Bryant Howren1, Michael A Steinman, Barry Carter
1Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL 32306.
Insights
Patient activation interventions, including financial incentives, effectively increased thiazide prescribing for hypertension. A combined intervention of a letter, financial incentive, and phone call significantly boosted medication switching rates.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Services Research
Background:
- Hypertension management often faces challenges with medication optimization.
- Calcium channel blockers (CCBs) are commonly used but may not be the most effective first-line agents.
- Clinical inertia can hinder the switch to more optimal antihypertensive medications like thiazides.
Purpose of the Study:
- To evaluate a patient activation intervention aimed at promoting the switch from CCBs to thiazides for hypertension control.
- To assess the impact of financial incentives and communication strategies on patient engagement in medication discussions.
Main Methods:
- A randomized clinical trial involving 236 patients with hypertension controlled on CCBs.
- Three intervention groups received varying combinations of letters, financial incentives, and phone calls to encourage discussion about switching to thiazides.
- A control group received no intervention.
Main Results:
- The rate of switching to thiazides was significantly higher in all intervention groups compared to the control group (9.4%–31.4% vs. 1.1%).
- The most comprehensive intervention (letter, incentive, phone call) showed the highest switching rate (31.4%).
- Adjusted analysis indicated patients in the comprehensive intervention group were significantly more likely to switch (OR, 4.14).
Conclusions:
- Low-cost, low-intensity patient activation interventions can effectively increase thiazide prescribing.
- These interventions can help overcome challenges in medication optimization and clinical inertia in hypertension management.
- Financial incentives and multi-component communication strategies enhance patient engagement in medication switching decisions.
Objectives:
To examine the effect of a patient activation intervention with financial incentives to promote switching to a thiazide in patients with controlled hypertension using calcium channel blockers (CCBs).
Study Design:
The Veterans Affairs Project to Implement Diuretics, a randomized clinical trial, was conducted at 13 Veterans Affairs primary care clinics.
Methods:
Patients (n = 236) with hypertension previously controlled using CCBs were randomized to a control group (n = 90) or 1 of 3 intervention groups designed to activate patients to talk with their primary care providers about switching to thiazides: Group A (n = 53) received an activation letter, group B (n = 42) received a letter plus a financial incentive to discuss switching from a CCB to a thiazide, and group C (n = 51) received a letter, a financial incentive, and a telephone call encouraging patients to speak with their primary care providers. The primary outcome was thiazide prescribing at the index visit.
Results:
At the index visit, the rate of switching to a thiazide was 1.1% in the control group and 9.4% (group A), 26.2% (group B), and 31.4% (group C) for the intervention groups (P < .0001). In adjusted analysis, patients randomized to group C were significantly more likely to switch from a CCB to thiazide at the index visit (odds ratio, 4.14; 95% CI, 1.45-11.84; P < .01).
Conclusions:
This low-cost, low-intensity patient activation intervention resulted in increased rates of switching to a thiazide in those whose hypertension was controlled using another medication, suggesting that such interventions may be used to overcome medication optimization challenges, including clinical inertia.
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