Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south.

BACKGROUND:Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty. AIM:This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient. SETTING:Free clinic in the United States rural south. PARTICIPANTS:Twenty-four patients with comorbid hypertension and type 2 diabetes. METHODS:A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention. RESULTS:A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%. CONCLUSIONS:The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.

Duke Scholars

Author Jennie De Gagne School of Nursing