Abstract 116: The Effect of a Practice-based Multi-component Intervention That Includes Health Coaching on Medication Adherence and Blood Pressure Control in Rural Primary Care

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Jia-Rong Wu ◽  
Doyle M Cummings ◽  
Quefeng Li ◽  
Jacquie Halladay ◽  
Katrina Donahue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Medication Adherence ◽  
Mixed Effects ◽  
Health Coaching ◽  
Quality Improvement Intervention ◽  
Linear Mixed Effects ◽  
Rural Primary Care ◽  
Improvement Intervention

Background: Lower adherence to anti-hypertensive medications contributes to sub-optimal patient outcomes, yet there are few successful interventions in rural primary care that target improved adherence. The purpose of this study was to determine whether a multi-component quality improvement intervention that included literacy-sensitive health coaching with motivational interviewing was associated with improved medication adherence and reductions in blood pressure (BP) in patients with a history of uncontrolled hypertension (HTN). Methods: Adult patients in six rural primary care settings with one or more visits in the last year with a systolic BP > 150 mmHg were recruited. Project faculty facilitated systematic changes in care delivery in local practices. Patients also received monthly phone-based literacy-sensitive health coaching including a focus on medication adherence, and a BP cuff for home monitoring. Data regarding medication adherence (Morisky Medication Adherence Scale-8) and BP were collected at baseline, 6, 12, 18, and 24 months. Linear mixed effects modeling was used to determine the effects of the multi-component intervention on medication adherence and whether changes in medication adherence were associated with changes in systolic and diastolic BP. Results: There were 477 patients enrolled; the majority were female, black, and reported an annual household income of < $40,000. At baseline, 39% of the patients had low medication adherence (MMAS-8 score < 6). In linear mixed effects models, the intervention resulted in modest increases in medication adherence [5.75 ± 1.37 at baseline to 5.94 ± 1.33 at 24 months (p = .04)]. Corresponding changes in BP were: from 138.6 ± 21.8/81.6 ± 12.9 mmHg at baseline to 132.7 ± 19.5/76.1 ± 14.5 mmHg at 24 months follow-up [mean 0.22-0.25/0.24-0.26 mmHg per month before and after adjustment for covariates (p < .001)]. Changes in medication adherence were significantly associated with reductions in diastolic BP longitudinally (p = .047). Conclusion: A practice-based quality improvement intervention that includes health coaching is associated with improvements in medication adherence and BP, and offers promise as a clinically applicable intervention in rural primary care.

scholarly journals A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices

2016 ◽  
Vol 19 (4) ◽  
pp. 351-360 ◽  
Author(s):  
Crystal W. Cené ◽  
Jacqueline R. Halladay ◽  
Ziya Gizlice ◽  
Katrina E. Donahue ◽  
Doyle M. Cummings ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Racial Disparities ◽  
Quality Improvement Intervention ◽  
Rural Primary Care ◽  
Care Practices ◽  
Primary Care Practices ◽  
Improvement Intervention

INTEGRATED PRIMARY CARE MENTAL HEALTH QUALITY IMPROVEMENT INTERVENTION

2016 ◽  
Vol 25 (12) ◽  
pp. 1010-1011 ◽  
Author(s):  
Joanne Cox ◽  
Hannah Durant ◽  
Natalie Castile ◽  
Sally Cheek ◽  
Katherine Dowd ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Quality Improvement ◽  
Integrated Primary Care ◽  
Quality Improvement Intervention ◽  
Primary Care Mental Health ◽  
Health Quality ◽  
Improvement Intervention

scholarly journals Prescription of blood pressure lowering treatment after intracerebral haemorrhage: Prospective, population-based cohort study

2020 ◽  
pp. 239698732097572
Author(s):  
Karl Bonello ◽  
Amy PK Nelson ◽  
Tom J Moullaali ◽  
Rustam Al-Shahi Salman ◽  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Quality Improvement ◽  
Hospital Discharge ◽  
Intracerebral Haemorrhage ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Population Based ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

Introduction Blood pressure (BP) lowering reduces the risk of recurrent stroke after intracerebral haemorrhage (ICH). However, implementation of BP lowering in clinical practice in the UK is unknown. Patients and methods We identified adults with first-ever incident ICH to quantify the proportion who survived >14 days after hospital discharge and were prescribed BP-lowering medication in a prospective, population-based, inception cohort study in the Lothian region of Scotland during June 2010–May 2012 and January–December 2019. After the first cohort, we analysed reasons for avoiding BP-lowering medication in a sample from the Lothian region of the Scottish Stroke Care Audit during January 2017–November 2017, which informed a quality improvement intervention that was implemented in the second cohort. Results After efforts to improve monitoring and lowering of BP amongst ICH survivors, there was an increase in the proportion of patients prescribed BP-lowering medication at hospital discharge between the first and second population-based cohorts (81/130 [62%] vs. 68/89 [76%]; P = 0.028). Compared with patients not prescribed BP-lowering medication at hospital discharge, patients prescribed BP-lowering medication presented with higher systolic BP (177 vs. 156 mm Hg, P = 0.002 and 180 vs. 149 mm Hg, P < 0.001, in the first and second population-based cohorts, respectively), and were more likely to have pre-morbid hypertension (85% vs. 33%, P < 0.001 and 72% vs. 29%, P < 0.001) and atrial fibrillation (35% vs. 4%, P < 0.001 and 26% vs. 5%, P < 0.034). Conclusion In this population-based study, the proportion of patients with ICH who were prescribed BP-lowering medication at hospital discharge increased after a quality improvement intervention.

scholarly journals Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
George A Samoutis ◽  
Elpidoforos S Soteriades ◽  
Henri E Stoffers ◽  
Theodora Zachariadou ◽  
Anastasios Philalithis ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

scholarly journals A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

2012 ◽  
Vol 62 (600) ◽  
pp. e478-e486 ◽  
Author(s):  
Jenny Woodman ◽  
Janice Allister ◽  
Imran Rafi ◽  
Simon de Lusignan ◽  
Jonathan Belsey ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Simple Approach ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

scholarly journals Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study

2019 ◽  
Vol 32 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Elysia Larson ◽  
Godfrey M Mbaruku ◽  
Jessica Cohen ◽  
Margaret E Kruk
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Quality Improvement Intervention ◽  
Implementation Evaluation ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Improvement Intervention

Abstract Objective To test the success of a maternal healthcare quality improvement intervention in actually improving quality. Design Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls. Setting Four districts in rural Tanzania. Participants Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline). Interventions In-service training, mentorship and supportive supervision and infrastructure support. Main outcome measures We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis. Results Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0–75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators. Conclusions A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.

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