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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3109 — Impact of a Peer Support Intervention Delivered in Veterans Service Organizations on Blood Pressure Control

Whittle J (Milwaukee VA Medical Center), Schapira MM (Milwaukee VA Medical Center), Fletcher K (Milwaukee VA Medical Center), Hayes A (Milwaukee VA Medical Center), Morzinski J (Medical College of Wisconsin), Ertl K (Medical College of Wisconsin), Eastwood D (Medical College of Wisconsin), Patterson L (Medical College of Wisconsin), Laud P (Medical College of Wisconsin)

Objectives:
Hypertension is the leading modifiable risk factor for stroke, and contributes importantly to risk of cardiovascular disease in general. Despite effective therapy, many affected individuals continue to be poorly controlled. As with many chronic conditions, self management is a key to controlling hypertension. Peer support may be a potent intervention to improve self management behaviors. We tested the effect of a novel, peer delivered, hypertension self management program on blood pressure (BP) control.

Methods:
We performed a cluster randomized controlled trial among posts of veterans service organizations. We invited 192 such posts to participate in a trial comparing two approaches to improving self management: a series of three professional-delivered seminars or a peer support intervention in which two post members would be educated to bring information about hypertension self management to each monthly meeting of that unit. Both groups received self management equipment including a scale, automated BP cuffs, and pedometers. We assessed program impact among volunteer post members with hypertension. Trained research assistants measured BP using aneroid sphygmomanometers at baseline, 6-months and 12-months. We used generalized estimating equations to account for the clustering of subjects within posts. Our primary endpoint was change in systolic BP at 12-months.

Results:
We approached 192 posts, of which 58 participated; they were randomized into two groups of 29 posts. Within these posts we recruited 404 study participants; mean age was 68.2 years. We had follow up data on 384 and 379 participants at 6-months and 12-months. respectively. At baseline, mean BP was 134.5/72.5 mmHg; BP was uncontrolled in 184 participants. At 6-months and 12-months, BP had decreased 1.6/0.4 and 4.3/1.9 mmHg, respectively. After adjusting for clustering and baseline BP, the decrease in BP was similar in the peer (1.8/0.2 and 4.7/2.3 mmHg at 6-months and 12-months) and seminar groups (1.5/0.6 and 3.7/1.4 mmHg at 6-months and 12-months), all p > 0.2. The odds of having uncontrolled BP at 12-months were similar in the two groups, though lower in the peer group (OR 0.69, 95% CI 0.38 – 1.21, p = 0.19).

Implications:
These interventions to improve self management were associated with similar, clinically important BP reductions in both groups.

Impacts:
Outreach to veterans organizations to encourage post support of chronic disease self management may improve chronic disease control in veteran members of these posts.


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