A primary healthcare information intervention for communicating cardiovascular risk to patients with poorly controlled hypertension: The Education and Coronary Risk Evaluation (Educore) study—A pragmatic, cluster-randomized trial


Autoři: Esperanza Escortell-Mayor aff001;  Isabel del Cura-González aff001;  Elena Ojeda-Ruiz aff004;  Teresa Sanz-Cuesta aff001;  Isidro Rodríguez-Salceda aff005;  Jesús García-Soltero aff006;  María-José Rojas-Giraldo aff007;  Pedro Herrera-Municio aff006;  Alicia Jorge-Formariz aff005;  Ángela Lorenzo-Lobato aff008;  Luisa Cabello-Ballesteros aff009;  Rosario Riesgo-Fuertes aff002;  Sofía Garrido-Elustondo aff002;  Mariel Morey-Montalvo aff001;  Milagros Rico-Blázquez aff001;  Ricardo Rodríguez-Barrientos aff001;  María-Dolores Fuente-Arriaran aff013;  Gloria Sierra-Ocaña aff014;  Encarnación Serrano-Serrano aff015;  Carmelina Sanz-Velasco aff013;  Roberto Carrascoso-Calvo aff005;  Juan Carlos Recio-Velasco aff016;  Marta Sanz-Sanz aff017;  Mercedes Rumayor-Zarzuelo aff018;  Olga-Inés Bermejo-Mayoral aff005;  Josefina Galán-Esteban aff006;  Antonio Sarría-Santamera aff002
Působiště autorů: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain aff001;  Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain aff002;  Área Medicina Preventiva y Salud Pública, Departamento Especialidades Médicas y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain aff003;  Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain aff004;  Centro de Salud La Veredilla, Torrejón de Ardoz, Madrid, Spain aff005;  Centro de Salud Santa Isabel, Madrid, Spain aff006;  Centro de Salud Parque Loranca, Fuenlabrada, Madrid, Spain aff007;  Centro de Salud Alcalá de Guadaira, Madrid, Spain aff008;  Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Noroeste, Madrid, Spain aff009;  Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sur. Getafe, Madrid, Spain aff010;  Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sureste, Madrid, Spain aff011;  Servicio de Prevención de la Enfermedad, Subdirección General de Promoción, Prevención y Educación para la Salud, Dirección General de Salud Pública, Madrid, Spain aff012;  Centro de Salud Sector 3, Getafe, Madrid, Spain aff013;  Centro de Salud Manuel Merino, Alcalá de Henares, Madrid, Spain aff014;  Centro de Salud Los Fresnos, Torrejón de Ardoz, Madrid, Spain aff015;  Centro de Salud Andrés Mellado, Madrid, Spain aff016;  Centro de Salud Las Águilas, Madrid, Spain aff017;  Área Única de Salud Pública-2, Dirección General de Salud Pública, Madrid, Spain aff018;  Departamento de Gestión de Servicios Sanitarios, Escuela Nacional de Sanidad, Instituto de Salud Carlos III (ISCIII), Madrid, Spain aff019;  Facultad de Medicina y Farmacia, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain aff020
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226398

Souhrn

Purpose

Uncertainty exists regarding the best way to communicate cardiovascular risk (CVR) to patients, and it is unclear whether the comprehension and perception of CVR varies according to the format used. The aim of the present work was to determine whether a strategy designed for communicating CVR information to patients with poorly controlled high blood pressure (HBP), but with no background of cardiovascular disease, was more effective than usual care in the control of blood pressure (BP) over the course of a year.

Methods

A pragmatic, two-arm, cluster-randomized controlled trial was performed. Consecutive patients aged 40–65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), were recruited at 22 primary healthcare centres. Eleven centres were randomly assigned to the usual care arm, and 11 to the informative intervention arm (Educore arm). At the start of the study, the Educore arm subjects were shown the "low risk SCORE table", along with impacting images and information pamphlets encouraging the maintenance of good cardiovascular health. The main outcome variable measured was the control of HBP; the secondary outcome variables were SCORE table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life.

Results

The study participants were 411 patients (185 in the Educore arm and 226 in the usual care arm). Multilevel logistic regression showed that, at 12 months, the Educore intervention achieved better control of HBP (OR = 1.57; 1.02 to 2.41). No statistically significant differences were seen between the two arms at 12 months with respect to the secondary outcomes.

Conclusions

Compared to usual care, the Educore intervention was associated with better control of HBP after adjusting for age, baseline SBP and plasma cholesterol, at 12 months.

Klíčová slova:

Antihypertensives – Blood pressure – Cardiovascular diseases – Communications – Hypertension – Cholesterol – Patients – Quality of life


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