Clinical research studyThe Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control
Section snippets
Study Design
The V-STITCH trial was a 2-year cluster randomized control trial. The interventions occurred at 2 levels: provider and patient. Primary care providers were first randomized to receive either the computer decision support system focusing on hypertension medication management delivered at the point of care during patient visits or usual care without the decision support interface. Within each participating provider's primary care panel, patients with hypertension were then randomized to receive
Results for Patients with Diabetes: HbA1c
Of the 588 veterans enrolled in V-STITCH, there were 219 patients with diabetes (117 patients in the usual care arm and 102 patients in the intervention group). Of these, 216 patients had HbA1c measurements available for analysis and were included in the analysis. The Figure shows the patient flow from patient enrollment in the parent V-STITCH study, with the 2 cohorts identified for analysis in the present study. Patient characteristics for the patient sample with diabetes are shown in Table 1
Discussion
In a randomized controlled trial of a nurse-administered tailored self-management intervention to improve blood pressure control, we evaluated the effect of the intervention on the unintended targets of diabetes and cholesterol control over 2 years. There was a modest difference in glycemic control between intervention and usual care patients that was statistically significant. There was no evidence of an intervention effect on LDL-C. There did not appear to be any significant difference in the
Acknowledgements
This research is supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, investigator initiative grant 20-034. The first author was supported by Grant Number KL2 RR024127 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view
References (36)
- et al.
Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk
Lancet
(2005) - et al.
Self-management approaches for people with chronic conditions: a review
Patient Educ Couns
(2002) - et al.
Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes
Lancet
(2004) - et al.
Self-management interventions for chronic illness
Lancet
(2004) - et al.
The veterans' study to improve the control of hypertension (V-STITCH): design and methodology
Contemp Clin Trials
(2005) - et al.
Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention
Patient Educ Couns
(2005) - et al.
Patients' perceived barriers to active self-management of chronic conditions
Patient Educ Couns
(2005) - et al.
Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation
(2008) - et al.
Risk factor thresholds: their existence under scrutiny
BMJ
(2002) - et al.
Effect of a multifactorial intervention on mortality in type 2 diabetes
N Engl J Med
(2008)
Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes
JAMA
Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients
J Gen Intern Med
Therapeutic goal attainment in patients with hypertension and dyslipidemia
Med Care
Patient self-management of chronic disease in primary care
JAMA
Crossing the Quality Chasm: A New Health System for the 21st Century
Meta-analysis: chronic disease self-management programs for older adults
Ann Intern Med
Multiple risk factor interventions for primary prevention of coronary heart disease
Cochrane Database Syst Rev
Dietary advice for reducing cardiovascular risk
Cochrane Database Syst Rev
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Funding: This research is supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, investigator initiative grant 20-034. The first author was supported by Grant Number KL2 RR024127 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR, NIH, or Department of Veterans Affairs.
Conflict of Interest: None.
Authorship: All authors had access to the data and contributed to writing the manuscript.