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Effectiveness of Mailed Patient Activation Letters for Blood Pressure Control: A Randomized Quality Improvement Trial
Mike K W Cheng1, Michael O Eseigbe2, Jaime H Orozco3
1Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA. mike.cheng@ucsf.edu.
Insights
Mailed letters with hypertension medication suggestions did not improve blood pressure control. The intervention did not effectively activate patients to manage their hypertension.
Area of Science:
- Cardiology
- Public Health
- Health Informatics
Background:
- Uncontrolled hypertension (HTN) is a significant preventable cause of mortality.
- Effective patient activation strategies are needed to improve blood pressure (BP) management.
- Interventions should motivate patients to collaborate with clinicians for BP control.
Purpose of the Study:
- To evaluate if mailing patients letters with algorithm-generated medication suggestions improves BP control.
- To assess the impact of targeted information on patient engagement in hypertension management.
- To determine if enhanced communication strategies lead to better BP outcomes.
Main Methods:
- A randomized quality improvement trial was conducted.
- Patients with diagnosed HTN and uncontrolled BP were recruited from an academic medical center.
- Participants were assigned to receive either a BP Activate Letter, a Control Letter, or no mailed outreach.
Main Results:
- The primary outcome (time to medication intensification or BP control) did not significantly differ between the BP Activate Letter group and the No Letter group.
- No significant improvement in secondary outcomes or subgroups was observed.
- The Control Letter group showed a significantly longer time to medication intensification compared to the No Letter group.
Conclusions:
- Mailing a single letter with computerized medication suggestions did not effectively activate patients for hypertension management.
- The intervention did not demonstrate a significant impact on BP control processes or outcomes.
- Further research is needed to develop effective patient activation strategies for hypertension.
Background:
Uncontrolled hypertension (HTN) is a leading preventable cause of death. Interventions are needed that activate patients and motivate them to work with clinicians to control their blood pressure (BP).
Objective:
To test whether mailing patients a letter including information about their hypertension and a summary of computerized algorithm-generated medication adjustment suggestions improves BP control processes and outcomes.
Design:
Randomized quality improvement trial.
Participants:
We identified patients receiving primary care at a large academic medical center with diagnosed HTN and uncontrolled BP (> 140 mmHg systolic or > 90 mmHg diastolic) at both of their last 2 visits.
Interventions:
Participants were randomized into three groups. The BP Activate Letter group received a letter containing algorithm-generated BP medication adjustment suggestions, and a recommendation to discuss these suggestions with their provider; the Control Letter group received a letter that recommended they talk to their provider about their HTN, without specific medication suggestions; and the No Letter group received no mailed outreach.
Main Measures:
The primary outcome was time to occurrence of either a BP medication intensification or documented achievement of BP control to < 140/< 90 mmHg using EHR data extracted 6 months after letters were mailed.
Key Results:
The primary outcome, which was time to medication intensification or achievement of BP control, did not occur more frequently in the BP Activate Letter group (hazard ratio = 0.86; 95% confidence interval [CI]: 0.65 to 1.14), or in the Control Letter group (0.78; 0.59 to 1.03) compared to the No Letter group, and we saw no evidence of significant improvement in any secondary outcome or subgroup. Time to medication intensification appeared to be significantly longer in the Control Letter compared to the No Letter group (0.50; 0.30 to 0.85).
Conclusions:
Mailing patients one letter with computerized BP medication adjustment suggestions to consider did not lead to effective patient activation.
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