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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3112 — The Persistent Clinical Benefits of Participating in a Hypertension Self-Management Trial

Maciejewski MLBosworth HBOlsen MKSmith VAEdelman DPowers BJKaufman MAOddone EZ, and Jackson GL, Durham COE;

Objectives:
Nurse-led hypertension self-management has been shown to improve blood pressure (BP) control, but it is unclear whether the clinical and economic benefits of participation in a hypertension self-management (HSM) trial are sustained after the conclusion of the intervention. We examine whether the clinical and economic benefits realized during the HSM trial persist 18 months after trial completion.

Methods:
Secondary long-term analysis of an 18 month 4-arm HSM trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 telephone-based intervention groups: (1) nurse-administered behavioral management (BEH), (2) nurse- and physician-administered medication management (MED), or (3) a combination of both (COMB). Intervention telephone calls were triggered by home BP values transmitted via telemonitoring devices. Behavioral management involved promotion of health behaviors. Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines. Clinic-derived systolic blood pressure (SBP) obtained from the Clinical Data Warehouse before, during and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures and total expenditures obtained from the Decision Support System were estimated using generalized estimating equations.

Results:
Relative to usual care, SBP improved in the COMB arm during the trial (2.7 mmHg at 12 months, 95% CI [-5.1, -0.3]; 2.7 mmHg at 15 months, 95% CI [-5.2, -0.3]), dissipated (0.8 mmHg at 9 months post-trial, 95% CI [-3.6, 2.1]) and was significantly better (6.1 mmHg, 95% CI [-10.8, 1-.5]) 18 months post-trial. SBP trends improved similarly during the trial in the BEH, MED, and usual care arms. Eighteen months post-trial, SBP in the BEH and MED arms improved relative to usual care. Inpatient admissions, outpatient expenditures and total expenditures were similar across all four study arms during and after the trial.

Implications:
The clinical benefits of participation in a HSM trial dissipated, then improved nearly two years after trial completion. The clinical benefits during the trial did not translate into reduced VA expenditures.

Impacts:
As VA cares for an increasing number of Veterans, there is a great need for interventions, such as HSM combined with medication management, that provide persistent clinical benefits.


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