Evidence Synthesis: Hypertension Medication Adherence & Intensification

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00682968
First received: May 20, 2008
Last updated: July 8, 2014
Last verified: July 2014
  Purpose

Hypertension affects nearly 50 million Americans [1] and is the most common chronic condition among veterans. Unfortunately, many patients with established hypertension have poorly controlled blood pressure (BP); control rates in the VA are at approximately 70% currently. While clinician failure to aggressively manage hypertension through therapeutic intensification (clinical inertia, or failure to intensify pharmacotherapy appropriately) contributes to poor blood pressure control, even when doctors do intensify therapy, 43-78% of patients fail to adhere to recommended therapies, indicating that adherence remains a central problem in hypertension care. This suggests important opportunities for interventions to improve risk factor control by working through clinicians, their teams, or their delivery systems, as well as with patients, to address both patient adherence and clinical inertia.


Condition
Hypertension

Study Type: Observational
Official Title: Evidence Synthesis: Hypertension Medication Adherence & Intensification

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • Medication adherence, physician guideline adherence [ Time Frame: varies ] [ Designated as safety issue: No ]

Enrollment: 20
Study Start Date: July 2008
Study Completion Date: October 2008
Primary Completion Date: September 2008 (Final data collection date for primary outcome measure)
Groups/Cohorts
Group 1
This entry into clinicaltrials.gov describes the interview portion of the project. The main part of the project entails synthesizing literature on hypertension medication adherence and physician guideline adherece. The interview portion entails interviewing approximately 20 clinicians, authors/PIs and VA administrators re: what they think the barriers and facilitators may be to implementing the interventions.

Detailed Description:

Background:

Hypertension affects nearly 50 million Americans [1] and is the most common chronic condition among veterans. Unfortunately, many patients with established hypertension have poorly controlled blood pressure (BP); control rates in the VA are at approximately 70% currently. While clinician failure to aggressively manage hypertension through therapeutic intensification (clinical inertia, or failure to intensify pharmacotherapy appropriately) contributes to poor blood pressure control, even when doctors do intensify therapy, 43-78% of patients fail to adhere to recommended therapies, indicating that adherence remains a central problem in hypertension care. This suggests important opportunities for interventions to improve risk factor control by working through clinicians, their teams, or their delivery systems, as well as with patients, to address both patient adherence and clinical inertia.

Objectives:

Recognizing the importance of understanding and intervening to improve adherence to antihypertensive medications and to address clinical inertia, VA HSR&D has funded numerous studies in the last decade to address these issues, either through interventions or through exploratory studies to better understand the problems. There has been little discussion among investigators and clinical managers as to the comparative effectiveness of such approaches -- which practices are 'best' for use in VA, based on the evidence emerging from these studies. Thus, we conducted an evidence synthesis project to accomplish these aims, in order to summarize the literature and facilitate exchange among investigators and clinicians on the implications of this growing body of VA research.

Methods:

We sought to catalog and extensively describe all VA funded studies conducted over the past decade focusing on adherence to antihypertensive medications, therapeutic intensification, or both. We also included non-VA funded studies focused on the care of veterans receiving health care in VA. We aimed to describe gaps in current research and identify important areas for future research, synthesize results from the studies, whether published or unpublished, in the form of an evidence synthesis, and to build on these efforts to develop more formal exchange and collaboration among VA researchers and clinicians working on addressing these important issues.

Status:

Complete.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

VA clinicians, hospital administrators and PIs/authors of above studies

Criteria

Inclusion Criteria:

  • Studies funded by VA from 1998 to the present looking at hypertension medication adherence and physician adherence to hypertension guidelines

Exclusion Criteria:

  • N/A
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00682968

Locations
United States, Massachusetts
VA Medical Center, Jamaica Plain Campus
Boston, Massachusetts, United States, 02130
Sponsors and Collaborators
Investigators
Principal Investigator: Nancy R. Kressin, PhD VA Medical Center, Jamaica Plain Campus
  More Information

Publications:
Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT00682968     History of Changes
Other Study ID Numbers: SHP 08-187
Study First Received: May 20, 2008
Last Updated: July 8, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
patient non-adherence
antihypertensive agents
hypertension

Additional relevant MeSH terms:
Hypertension
Vascular Diseases
Cardiovascular Diseases
Antihypertensive Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on August 28, 2014