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Home > "G" Clinical Trials Conditions > Guidelines for Drug Therapy of Hypertension: Closing the Loop  Guidelines for Drug Therapy of Hypertension: Closing the Loop
Guidelines for Drug Therapy of Hypertension: Closing the Loop
For Condition: Hypertension
Status: Completed
Sponsor(s): Department of Veterans Affairs , Department of Veterans Affairs Health Services Research and Development Service,Stanford University
Synopsis: Hypertension is a major risk factor for heart disease and stroke. Evidence-based guidelines support the use of specific drugs for patients with specific comorbidities to maximize the decrease in cardiovascular risk; yet, many physicians do not follow these guidelines in choosing drug therapy. The goal of this project was to evaluate methods of implementing clinical practice guidelines, using hypertension as a model. We hypothesized that providing patient-specific recommendations to clinicians at the time of clinic contact with hypertensive patients would substantially improve guideline concordance of drug therapy without adversely affecting (possibly improving) blood pressure control. Our long-term goal is to develop and evaluate methods of implementing clinical practice guidelines that build on current knowledge about the most effective approaches to changing clinician behavior, and to extend those methods to other cardiovascular diseases. This project, known as ATHENA, included two major components: (1) We conducted a randomized controlled trial of patient-specific recommendations about drug therapy for hypertension, delivered to primary care clinicians at the time of primary care clinic visits. The recommendations were based on VA Hypertension Guidelines. The trial included 36 clinicians and 4500 hypertensive patients enrolled in primary care clinics at VA Palo Alto Health Care System. We compared a general intervention to an individualized intervention. Both the general and the intervention groups of clinicians received extensive guideline education, as part of a VISN-mandated hypertension guideline implementation. Clinicians randomized to the individualized intervention received, in addition, computer-generated patient-specific recommendations about drug therapy of hypertension, delivered to the clinics with the encounter forms for each visit. (2) In the 2nd major component of the study, we collaborated with Stanford Medical Informatics to develop a hypertension decision support system (ATHENA DSS). ATHENA DSS combines detailed patient information from the VA electronic medical record (VistA) with hypertension guideline knowledge based on the VA and JNC 6 hypertension guidelines. A special feature of ATHENA DSS is that the knowledge in the system can be easily browsed and updated by clinician-managers, so that knowledge can be kept up to date with emerging clinical trial findings about best treatments. We developed an infrastructure to implement the system in a pop-up window in the CPRS-GUI in the primary care clinics at VA Palo Alto. We also conducted an offline test of the program logic by comparing the ATHENA DSS recommendations with those made by a physician for 100 randomly selected VA patients.
Details:
Eligibility:
Study Type: Interventional, Educational/Counseling/Training, Randomized, Single Blind, Active Control, Parallel Assignment
Minimum Age/Maximum Age: /
Genders: Both
Protocol Entry Criteria: Subjects were primary care clinicians, both physicians and nurse practitioners, at a large VA medical center. Patients were not subjects in this study.
Total Enrollment: 36
Location and Contact Information:
VA Palo Alto Health Care System
Palo Alto, California, 94304-1207
United States
Additional Information:
Study ID Numbers: CPG 97-006;
Study Start Date: January 1998
Record last reviewed: December 2000
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00012636
Other Hypertension Studies:
1. Blood Sampling for Neurochemical and Genetic Testing
2. Improving Hypertension Care for Inner City Minorities
3. Genetic Analysis of Human Hypertensive End Stage Renal Disease (H-ESRD)
4. The SAPPHIRE Study (Systolic And Pulse Pressure Hemodynamic Improvement By Restoring Elasticity)
5. The Role of Cyclooxygenase Activity in the Endothelial Function of Hypertensive and Hypercholesterolemic Patients
Related Studies:
Other Hypertension Clinical Trials
Other California Clinical Trials
Other Palo Alto Clinical Trials
Guidelines for Drug Therapy of Hypertension: Closing the Loop
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