A Collaborative Model to Improve Blood Pressure (BP) Control and Minimize Racial Disparities

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
University of Iowa
ClinicalTrials.gov Identifier:
NCT00935077
First received: July 6, 2009
Last updated: July 9, 2014
Last verified: July 2014
  Purpose

The purpose of the study is to determine the degree to which pharmacist-physician collaborative management (PPCM) of hypertension can be adopted and implemented in clinics with geographic and racial diversity and whether patients in clinics which implement PPCM achieve greater blood pressure control than patients in clinics which do not implement PPCM.

Primary Hypothesis: BP control at 9 months will be significantly greater in patients from clinics randomized to the two PPCM BP intervention groups compared to the control group.


Condition Intervention Phase
Hypertension
Asthma
Other: PPCM Asthma
Other: 24 Month PPCM BP
Other: 9 Month PPCM BP
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: A Collaborative Model to Improve BP Control and Minimize Racial Disparities-CCC

Resource links provided by NLM:


Further study details as provided by University of Iowa:

Primary Outcome Measures:
  • Blood Pressure Control [ Time Frame: 9 Months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Blood Pressure Control [ Time Frame: 24 Months ] [ Designated as safety issue: No ]

Enrollment: 1441
Study Start Date: January 2010
Study Completion Date: March 2014
Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 24 Month PPCM BP
A 24 month long physician/pharmacist collaborative intervention is implemented to manage hypertension
Other: 24 Month PPCM BP
Pharmacists collaborate with physicians for 24 months to manage hypertension.
Experimental: 9 Month PPCM BP
A 9 month long physician/pharmacist collaborative intervention is implemented to manage hypertension
Other: 9 Month PPCM BP
Pharmacists collaborate with pharmacists for 9 months to manage hypertension
Sham Comparator: PPCM Asthma
A 9 month long physician/pharmacist collaborative intervention is implemented to manage asthma
Other: PPCM Asthma
Pharmacists collaborate with physicians to manage asthma
No Intervention: BP Control Arm
No PPCM intervention

Detailed Description:

Blood pressure (BP) is controlled in only 34% of patients with high BP, leading to unnecessary strokes, myocardial infarctions and other cardiovascular events. BP control can be improved with physician/ pharmacist collaborative management (PPCM). Our long-range goal is to achieve excellent BP control rates using PPCM that can be implemented in private practices in diverse communities. The objective of this application is to conduct a large multi-center clinical trial in clinics with geographic, racial and ethnic diversity to determine the extent to which the model is implemented. This practice-based research network (PBRN) is unique with a large minority population and great diversity in operation and community size. This prospective, cluster-randomized trial uses 27 clinics, matched and randomized to the active intervention (2 groups) or a control group in 648 patients. Following 9 months of the intervention, one intervention group will continue the intervention following 9 months while the other will discontinue it. We will also randomize 18 patients per clinic into a passive observation group (n=486) to determine if PPCM is implemented more broadly in the clinic. Patients in all three groups will be followed for 24 months. We will accomplish our objectives and test our central hypothesis by pursing the following aims:

Aim 1: To determine if patients in clinics randomized to PPCM can achieve better BP control at 9 months compared to patients in clinics randomized to the control group.

Primary Hypothesis: BP control at 9 months will be significantly greater in patients from clinics randomized to the two PPCM BP intervention groups compared to the control group.

Aim 2: To determine if patients in clinics randomized to continuation of PPCM achieve better long-term BP control compared to patients in clinics randomized to discontinuation of PPCM after 9 months and to patients in control clinics.

Our innovative approach addresses critical organizational barriers and challenges existing approaches to achieving better BP control. This study is novel because it will: 1) be the largest study to test this model, 2) use a cluster randomized design to include many more clinics than previously used, 3) use a diverse group of clinics with broad geographic distribution, 4) include large numbers of patients from minority groups to assess potential health disparities, 5) evaluate whether the effect can be sustained long-term, 6) include standardized BP measurements rather than error-prone office BPs, 7) minimize selection bias, and 8) evaluate a "passive observation group" to evaluate dissemination of PPCM throughout the practice. We expect that our study will find a 6-8 mm Hg difference in systolic BP which would lead to 20-30% fewer coronary deaths and 25-40% fewer stroke deaths if applied across broadly across similar settings.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. English or Spanish speaking males or females, over 18 years of age with a diagnosis of hypertension,
  2. have uncontrolled BP defined as > 140 mm Hg SBP or > 90 mm Hg DBP for patients with uncomplicated hypertension; or > 130 mm Hg SBP or > 80 mm Hg DBP for patients with diabetes or chronic kidney disease, and
  3. receive care from one of the participating clinics.

Exclusion Criteria:

  1. current signs of hypertensive emergency (acute angina, stroke, or renal failure;
  2. severe HTN (systolic BP >200 or diastolic BP > 114 mm Hg);
  3. history of MI, stroke, or unstable angina in the prior 6 months;
  4. systolic dysfunction with a LV ejection fraction < 35% documented by echocardiography, nuclear medicine study, or ventriculography;
  5. renal insufficiency, defined by a glomerular filtration rate less than 20 ml/min or previously documented proteinuria > 1 gram per day;
  6. significant hepatic disease, including prior diagnoses of cirrhosis, Hepatitis B or C infection, or laboratory abnormalities (serum ALT or AST > 2 times control or total bilirubin > 1.5 mg/dl) in the prior 6 months;
  7. pregnancy;
  8. diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation);
  9. poor prognosis with a life expectancy estimated less than 2 years;
  10. residence in a nursing home or diagnosis of dementia; and
  11. inability to give informed consent or impaired cognitive function (defined as > 3 errors on the 10-item Pfeiffer Portable Mental Status Questionnaire, administered during study intake).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00935077

  Hide Study Locations
Locations
United States, California
University of California San Diego
San Diego, California, United States, 92093
United States, Connecticut
St. Francis Hospital Medical Center
Hartford, Connecticut, United States, 06105
United States, Florida
University of Florida
Gainesville, Florida, United States, 32601
University of South Florida
Tampa, Florida, United States, 33612
United States, Idaho
Idaho State University
Pocatello, Idaho, United States, 83209
United States, Illinois
Midwestern University
Downers Grove, Illinois, United States, 60515
United States, Iowa
Genesis Health System
Davenport, Iowa, United States, 52803
Broadlawns Medical Center
Des Moines, Iowa, United States, 50314
The University of Iowa
Iowa City, Iowa, United States, 52242-1112
Siouxland Medical Education Foundation
Sioux City, Iowa, United States, 51104
Northeast Iowa Medical Education Foundation
Waterloo, Iowa, United States, 50702
United States, Massachusetts
Cambridge Health Alliance
Cambridge, Massachusetts, United States, 02139
United States, New York
SUNY-University of Buffalo
Buffalo, New York, United States, 14260
United States, North Carolina
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States, 27559
Duke University
Durham, North Carolina, United States, 27705
Wake Forest University Health Sciences
Winston-Salem, North Carolina, United States, 27157
United States, Pennsylvania
Temple University
Philadelphia, Pennsylvania, United States, 19140
University of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29425
Spartanburg Regional Health Service District
Spartanburg, South Carolina, United States, 29303
United States, Texas
Texas Tech University Health Science Center
Amarillo, Texas, United States, 79106
Seton Healthcare
Austin, Texas, United States, 78701
University of Texas at El Paso
El Paso, Texas, United States, 79968
Memorial Hermann Hospital System
Houston, Texas, United States, 77030
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States, 78229
United States, Utah
University of Utah
Salt Lake City, Utah, United States, 84112-5820
United States, Wisconsin
University of Wisconsin
Madison, Wisconsin, United States, 53715
Wheaton Franciscan Medical Group
Milwaukee, Wisconsin, United States, 53210
Sponsors and Collaborators
University of Iowa
Investigators
Principal Investigator: Barry L. Carter, PharmD University of Iowa
  More Information

No publications provided by University of Iowa

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: University of Iowa
ClinicalTrials.gov Identifier: NCT00935077     History of Changes
Other Study ID Numbers: 1 R01 HL091841
Study First Received: July 6, 2009
Last Updated: July 9, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by University of Iowa:
Hypertension
Pharmacist Physician Collaborative Management of Hypertension

Additional relevant MeSH terms:
Asthma
Hypertension
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Vascular Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on August 26, 2014