Impact on hypertension control of patient-held guideline: a randomised controlled trial.

McKinstry, Brian, Hanley, Janet, Heaney, David, McLoughlan, Lucy, Elton, Rob and Webb, David (2006) Impact on hypertension control of patient-held guideline: a randomised controlled trial. British Journal of General Practice, 56 (532). pp. 842-847. ISSN 0960-1643

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Hypertension is generally poorly controlled in primary care. One possible intervention for improving control is the harnessing of patient expertise through education and encouragement to challenge their care.

To determine whether encouraging patients to manage their hypertension in an ‘expert’ manner, by providing them with information in a clear clinical guideline, coupled with an explicit exhortation to become involved in and to challenge their own care if appropriate, would improve their care.

Design of study
Single blind randomised controlled trial of detailed guideline versus standard information.

Single urban general practice over 1 year.

Patient-held guideline with written explicit exhortation to challenge care when appropriate. Two hundred and ninety-four of 536 eligible patients on the practice hypertension register were recruited, all of whom were randomised into one of two groups. Two hundred and thirty-six patients completed the study.

Primary outcome: average systolic blood pressure. Secondary outcomes: proportion of patients with blood pressure <150mmHg systolic and <90mmHg diastolic, average cholesterol, proportion of patients prescribed statins and aspirin according to guideline, hospital anxiety and depression score. No clinically, or statistically significant differences were found between intervention and control with respect to all parameters or in anxiety and depression levels. Statin and aspirin use improved throughout the course of the study in both groups. Statin use showed a trend (P = 0.02) in favour of control.

In this study there was no clinically significant perceived benefit to patients as a result of providing them with a hypertension guideline. Patient guidelines are currently planned for many chronic illnesses. It is important to determine the utility of such interventions before scarce resources are applied to them.

Item Type: Article
Print ISSN: 0960-1643
Uncontrolled Keywords: Clinical trials; Hypertension, Physician–patient relations, Primary health care, Self-care
University Divisions/Research Centres: Faculty of Health, Life & Social Sciences > School of Nursing, Midwifery and Social Care
Dewey Decimal Subjects: 600 Technology > 610 Medicine & health > 614 Incidence & prevention of disease
600 Technology > 610 Medicine & health > 616 Diseases
Library of Congress Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Item ID: 1613
Depositing User: RAE Import
Date Deposited: 29 May 2008 15:10
Last Modified: 31 Aug 2010 10:46

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