• Medication adherence, physician guideline adherence [ Time Frame: varies ] [ Designated as safety issue: No ]
  

Background:

Hypertension affects nearly 50 million Americans [1] and is the most common chronic condition among veterans. Unfortunately, many patients with established hypertension have poorly controlled blood pressure (BP); control rates in the VA are at approximately 70% currently. While clinician failure to aggressively manage hypertension through therapeutic intensification (clinical inertia, or failure to intensify pharmacotherapy appropriately) contributes to poor blood pressure control, even when doctors do intensify therapy, 43-78% of patients fail to adhere to recommended therapies, indicating that adherence remains a central problem in hypertension care. This suggests important opportunities for interventions to improve risk factor control by working through clinicians, their teams, or their delivery systems, as well as with patients, to address both patient adherence and clinical inertia.

Objectives:

We propose an evidence synthesis project to better facilitate exchange among investigators and clinicians on the implications of this growing body of VA research and to lay a solid foundation for implementation and dissemination of effective strategies to address clinical inertia and improve veterans adherence to antihypertensive medications, leading to improved clinical outcomes. In addition, we aim to develop a network of collaboration and exchange among VA researchers and clinicians addressing these issues. We intend for the processes fostered through this grant to provide a model for enhancing VA-wide community.

Methods:

Our research team will first meet to review the studies initially identified and to determine if any additional studies need to be added to the database.

We will obtain information from funded IIRs, SDPs, SDRs, CDAs and any other VA funding mechanisms we can identify. Next, the team will determine the parameters on which each study will need to be characterized (e.g. size of intervention effects, type of intervention). After abstracting the data, we will begin the synthesis of study results. Based on this, we will identify gaps and draft a document suggesting future research directions. Then, the team will conduct semi-structured qualitative interviews with study investigators and VA clinical leaders to assess the barriers and facilitators of each intervention identified. This information will be coded and codified into a document listing the common barriers and facilitators for each type of intervention, as well as a comprehensive list for all types of interventions. Finally, using both the study results and the information from the interviews, we will develop a set of recommendations for VA to use when considering implementation of future efforts to improve antihypertensive medication adherence and medication intensification.

Status:

Start-up activities.