Lisa A. Cooper|Debra Roter|Kathryn A. Carson|Lee Bone|Susan Larson|Edgar R. Miller|Michael S. Barr|David M. Levine
A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients
Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|American College of Physicians|Johns Hopkins Medicine|Johns Hopkins University
african americans persons low socioeconomic status ses disproportionately affected hypertension receive less patientcentered care less vulnerable patient populations moreover continuing medical education cme patientactivation interventions infrequently directed improve processes care populationsto compare effectiveness patientcentered interventions targeting patients physicians effectiveness minimal interventions underserved groupsrandomized controlled trial conducted january 2002 august 2005 patient followup 3 12 months 14 urban communitybased practices baltimore marylandfortyone primary care physicians 279 hypertension patientsphysician communication skills training patient coaching community health workersphysician communication behaviors patient ratings physicians participatory decisionmaking pdm patient involvement care pic reported adherence medications systolic diastolic blood pressure bp bp controlvisits trained versus control group physicians demonstrated positive communication change scores baseline 052 vs 082 p 004 12 months patientphysician intensive group compared minimal intervention group showed significantly greater improvements patient report physicians pdm 620 vs 524 p 003 pic dimensions related doctor facilitation 022 vs 017 p 003 information exchange 032 vs 022 p 0005 improvements patient adherence bp control differ across groups overall patient sample however among patients uncontrolled hypertension baseline nonsignificant reductions systolic bp observed among patients intervention groupsthe patientphysician intensive 132 mmhg physician intensivepatient minimal 106 mmhg patient intensivephysician minimal 168 mmhg compared patientphysician minimal group 20 mmhginterventions enhance physicians communication skills activate patients participate care positively affect patientcentered communication patient perceptions engagement care may improve systolic bp among urban africanamerican low ses patients uncontrolled hypertension