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Behavioral support from peers and primary care office staff canhelp patients improve their blood pressure control by as much asstarting a new drug, a new study found. Barbara J. Turner, M.D.,M.S.Ed., M.A., M.A.C.P., of UT Medicine San Antonio, is the seniorauthor. The randomized, controlled trial examined whether six months ofintervention - behavioral support from peers and primary careoffice staff - could benefit African-American patients who had poorcontrol of systolic pressure despite one to two years ofprescriptions and office visits. Systolic pressure is the force ofthe blood against vessels as the heart contracts. "These patients had previously failed to have their blood pressurecontrolled despite physicians continuing to intensity theirmedications, so we decided that adding more medicine just wasn'tgoing to work," Dr. Turner said. "You start to think, what otherthings could I do for this person rather than just pills?" The team focused the behavior support intervention especially onlowering blood pressure because it can be severe, even deadly, inits consequences, particularly for older African Americans. Theyare more likely than whites to die of heart disease and are less likely to achieve blood pressure control even withsimilar treatment, Dr. Turner said. Dr. Turner is professor in the School of Medicine at The Universityof Texas Health Science Center San Antonio and director of theREsearch to Advance Community Health (REACH) Center, acollaboration of the Health Science Center, the University HealthSystem and The University of Texas School of Public Health.Researchers conducted the study in two urban academic internalmedicine practices in Pennsylvania. Dr. Turner came to San Antoniofrom the University of Pennsylvania School of Medicine. In the study, funded by the Robert Wood Johnson Foundation,systolic pressure was reduced by 7.2 mmHg (millimeters of mercury)in the intervention group versus 0.8 mmHg in the control group - a6.4 mmHg greater reduction for the peer- and primary carestaff-based intervention. The study also aimed to reduce overallrisk of a heart attack or death from heart disease in the next four years. Theintervention group did reduce their heart disease risk more thanthe control group, but not enough to achieve a significantdifference in that outcome compared with the controls. The study was conducted in patients who were already affected bymultiple diseases. More than half of the participants had diabetes , nearly 1 in every 5 had suffered a heart attack or other coronary heart disease (CHD) event, and more than 2 in every 5 had depressive symptoms.Average age of the participants was 62. For the peer support intervention, the team trainedAfrican-American patients from the same practices as the studysubjects. This training program was conducted in collaboration withthe American Heart Association. The peer coaches were aged 50 orolder and had high blood pressure that was now well-controlled. The peer coaches spoke on the phonewith study participants several times over the course of the studyabout the serious nature of high blood pressure, why takingmedications is important and practical ways to adopt a healthierlifestyle. "Interestingly, the lead peer coach was an 85-year-old formerwedding planner," Dr. Turner said. "She was incredible. The bestpeer coaches were grateful to their doctors for helping them. Theywanted to pay back their so-called debt to the doctor and thoughtthis was a way to do it." Three African-American staff members (a medical assistant, alicensed nurse and a chronic disease educator) were also trained tooffer culturally appropriate slideshows developed by the team ontopics such as where to get healthy food and why the danger of stroke and heart attack requires taking blood pressure medication daily,even if the condition has no symptoms. "We also created an online program to show patients their heartdisease risk factors and what would happen to their risk of havinga heart attack within four years if they reduced one or more ofthese risk factors," Dr. Turner said. "We could show that the riskcould be reduced, sometimes a lot, by making a positive change." Aspects of a patient-centered medical home were employed, such asusing an electronic medical record to identify and then track theprogress of the participants. Dr. Turner said UT Medicine, the clinical practice of the School ofMedicine at the UT Health Science Center, and other practices inSan Antonio have patients who are also failing to achieve bloodpressure control goals despite medications and office visits.Behavioral support may help them achieve a safer blood pressure. Inaddition, studies with patients who have diabetes have also shown alikely benefit from peer- and primary care office-based behavioralsupport, Dr. Turner said. The research is reported in the Journal of General Internal Medicine. Additional References Citations. The e-commerce company in China offers quality products such as Fingerprint Door Lock , Mifare Card Lock, and more. For more , please visit Mifare Card Lock today!
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