Key result
Patient-directed educational materials and incentives to discuss thiazide diuretics did not significantly increase the rate of medication changes or lifestyle counseling compared to control (36.9% vs 35.7%), with physicians frequently citing perceived blood pressure control as the reason for clinical inertia.
Why the study?
Does a patient-directed educational intervention regarding thiazide diuretics alter physician prescribing behavior and improve blood pressure control in patients with uncontrolled hypertension?
RCT (n=269)
Open-label
Cluster randomized (by physician)
Yes
Does a patient-directed educational intervention regarding thiazide diuretics alter physician prescribing behavior and improve blood pressure control in patients with uncontrolled hypertension?
Absolute Event Rate: 36.9% vs 35.7%
p-value: p=0.84
Clinical inertia remains a major barrier to hypertension control, with physicians frequently citing perceived blood pressure control or home readings as reasons for not intensifying therapy despite objectively uncontrolled clinic blood pressures.
Patient-directed education fails to overcome inertia in uncontrolled hypertension; challenges this approach and supports testing physician-targeted strategies.
The purpose of this study was to evaluate the reasons physicians provided when the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines recommending a thiazide diuretic as a first line treatment for hypertension were not followed. A subsample of patients from a randomized controlled study who had uncontrolled blood pressure at an index visit and were not prescribed a thiazide were evaluated. Differences in groups that received any medication change or therapeutic lifestyle changes counseling and those that did not were compared. Differences in treatment were also compared for patients who received educational materials with or without telephone calls and financial incentive with a control group. The authors examined whether patients achieved blood pressure control in 12 months. The results show providers are not aggressive enough with getting blood pressure to goal and patients who are more educated about hypertension may be less likely to experience clinical inertia.
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Sutton et al. (2010) conducted an RCT in Uncontrolled hypertension (n=269). Patient-directed educational materials and financial incentives vs. Usual care (pure control) was evaluated on Medication change or therapeutic lifestyle counseling (TLC) (p=0.84). Patient-directed educational materials and incentives to discuss thiazide diuretics did not significantly increase the rate of medication changes or lifestyle counseling compared to control (36.9% vs 35.7%), with physicians frequently citing perceived blood pressure control as the reason for clinical inertia.
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