HypertensionNCT00129493
Group Visits to Improve Hypertension Management
A study testing Group medical visits in people with Hypertension, run by US Department of Veterans Affairs at 2 sites in United States.
Trial summary
This study investigates group medical visits as a quality improvement strategy for hypertension. It studies group visits in which patients see their own primary care provider together with other patients who have hypertension. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Hypertension
- What is being tested?
- Group medical visits
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 300 participants
- Where
- 2 sitesUnited States
- Study dates
- Feb 2004to Aug 2007
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Subjects include both health care professionals and their patients. The included health care professionals are primary care clinicians practicing at VA Palo Alto who have their own panels of patients for whom they provide primary care. Included patients are patients of these primary care clinicians; the patients must have a diagnosis of hypertension and at least one blood pressure in the previous year that was above guideline-target for that patient, and patient must be approved by the primary care clinician as suitable for a group medical visit.
Who cannot join
- Primary care clinicians with very small patient panels (too small for recruitment of patients for group visits) ae excluded. Patients are excluded by their primary care clinician using clinical judgment; typical reasons for exclusion include terminal illness, dementia that would make patient unable to participate in group discussions. Because primary care clinicians located at main study site do not provide primary care to children, no children will be included in the sample.
Trial locations and contacts
2 sites in 1 country.
United States2 sites
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, Massachusetts, 02130
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, California, 94304-1290
About this study
This study investigates group medical visits as a quality improvement strategy for hypertension. It studies group visits in which patients see their own primary care provider together with other patients who have hypertension. The group visits are intended to enhance the patient's self-efficacy for self-management of their chronic disease (hypertension).
Read the detailed description
BACKGROUND Many veterans with hypertension have poorly controlled blood pressure (BP); new strategies for quality improvement are needed. A new model of care delivery, Group Medical Visits, holds promise as a means to improve blood pressure control by enhancing patients' self-efficacy for self-management of their chronic disease.
Objectives The overriding goal of this implementation project is to translate research findings about management of hypertension into practice and thereby to improve patient outcome, i.e., adequacy of control of BP, in patients with hypertension. Specific objectives are to develop and implement a model of group medical visits in iterative steps; to evaluate whether group medical visits improve patient adherence to prescribed antihypertensive medications and improve BP control; and to assess patient, physician, and health care system factors involved in successfully making organizational changes to encompass group medical visits.
Methods Study site: primary care clinics at VA Palo Alto. Study Design: staircase design with 2 steps of design/implementation/formative-evaluation/redesign with increasing numbers of participants, followed by a 3rd step evaluating the final model. Participants: primary care providers (MDs and RNPs) and their patients with hypertension. Participating primary care providers (PCPs) are randomly allocated 2:1 Group Visits (GV)intervention:control; patients of intervention PCPs are also randomly allocated 2:1, yielding 3 study arms (patients of GV-PCPs enrolled in GVs; patients of GV-PCPs not in GVs, and patients of non-GV-PCPs). This design allows for comparison between control patients of primary care providers conducting group visits with primary care providers who do not participate in the group medical appointment intervention. Intervention: group medical visits of patients with their own PCP. Group visits include both education and medical care components. Organizational component: tracking of organizational issues in establishing the program of group visits; interviews with key stakeholders to identify barriers and facilitators to implementing the new model of care. Outcome measures: patients' blood pressures (BPs), medication adherence, satisfaction, and health-related quality of life; PCP satisfaction; qualitative analysis of themes from interviews for patient, physician, and medical center factors involved in making organizational changes to encompass group visits.
Findings We exceeded the target enrollment for primary care providers (PCPs) with a total of 16 (11 intervention, 5 control). We enrolled 296 patients; 7 had incomplete baseline data leaving 289 patients: 145 allocated to GVs, 73 control patients of GV-PCPs, and 71 control patients of control PCPs. We have also enrolled an additional 12 staff members for interviews, including the one PCP who did not elect to participate. Study arm comparisons will not be made until the final data collection is complete. In formative evaluations we found that patient medical needs were met in the group setting and that both patients and PCPs were satisfied with the GV format. PCPs and patients have requested that the GVs continue after the study ends. Space for the GVs has been a major barrier particularly in light of ongoing construction in the clinic building.
Status We are now in Step 3 with plans to end the intervention phase at the end of March 2006 and complete final data collection soon thereafter.
Impact Group Medical visits are a new model of health care delivery that hold promise for improving patient access, patient and provider satisfaction, and clinical outcomes.
- Conditions
- Hypertension
- Being tested
- Group medical visits
- Keywords
- Practice guidelines, Hypertension, Primary health care, Patient-centered care, Healthcare quality, Office visits, Self-efficacy, Self care, Guideline adherence, Patient noncompliance
- Medical subject headings
- Hypertension, Patient Compliance
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Group medical visitsBehavioural
Our intervention aims to develop and implement a model of group medical visits in iterative steps, to evaluate whether group medical visits improve patient adherence to prescribed antihypertensive medications and improve BP control, and to assess patient, physician, and health care system factors involved in successfully making organizational changes to encompass group medical visits.
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 | Other | Not described Receives: Behavioral: Group medical visits |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in blood pressure from baseline to endpoint (6, 12 or 18 months depending on how long patient is in study) and comparisons of study arms; change inmedication adherence from baseline to endpoint. Formative evaluation of the program.
Measured: 6, 12, 18 months
Secondary outcomes (1)
Patient, provider and other staff satisfaction; organizational impact of the group visits program (health care system factors exploratory analyses of utilization)added value of visits beyond 12 months, qualitative data from interviews.
Measured: 18 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Aug 2005 (estimated)
- Study startFeb 2004
- Primary completionMar 2006
- Study completionAug 2007
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for HypertensionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- US Department of Veterans Affairs
- Sponsor type
- US federal agency
- Responsible party
- Sponsor
- Investigators
- Mary K. Goldstein, MD MS, Principal investigator, VA Palo Alto Health Care System, Palo Alto, CA
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00129493
- Sponsor's protocol ID
- TRH 01-173
- Status last verified
- May 2009
- First submitted
- 9 Aug 2005
- Last updated
- 7 Apr 2015
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 7 Apr 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Group Visits to Improve Hypertension Management
- ClinicalTrials.gov ID
- NCT00129493
- Acronym / sponsor ID
- TRH 01-173
- Conditions
- Hypertension
- Keywords
- Practice guidelines, Hypertension, Primary health care, Patient-centered care, Healthcare quality, Office visits, Self-efficacy, Self care
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- US Department of Veterans AffairsUS federal agency
- Study start
- Feb 2004
- Primary completion
- Mar 2006 (actual)
- Study completion
- Aug 2007 (actual)
- First posted
- 11 Aug 2005 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study investigates group medical visits as a quality improvement strategy for hypertension. It studies group visits in which patients see their own primary care provider together with other patients who have hypertension. The group visits are intended to enhance the patient's self-efficacy for self-management of their chronic disease (hypertension).
Detailed description
BACKGROUND Many veterans with hypertension have poorly controlled blood pressure (BP); new strategies for quality improvement are needed. A new model of care delivery, Group Medical Visits, holds promise as a means to improve blood pressure control by enhancing patients' self-efficacy for self-management of their chronic disease.
Objectives The overriding goal of this implementation project is to translate research findings about management of hypertension into practice and thereby to improve patient outcome, i.e., adequacy of control of BP, in patients with hypertension. Specific objectives are to develop and implement a model of group medical visits in iterative steps; to evaluate whether group medical visits improve patient adherence to prescribed antihypertensive medications and improve BP control; and to assess patient, physician, and health care system factors involved in successfully making organizational changes to encompass group medical visits.
Methods Study site: primary care clinics at VA Palo Alto. Study Design: staircase design with 2 steps of design/implementation/formative-evaluation/redesign with increasing numbers of participants, followed by a 3rd step evaluating the final model. Participants: primary care providers (MDs and RNPs) and their patients with hypertension. Participating primary care providers (PCPs) are randomly allocated 2:1 Group Visits (GV)intervention:control; patients of intervention PCPs are also randomly allocated 2:1, yielding 3 study arms (patients of GV-PCPs enrolled in GVs; patients of GV-PCPs not in GVs, and patients of non-GV-PCPs). This design allows for comparison between control patients of primary care providers conducting group visits with primary care providers who do not participate in the group medical appointment intervention. Intervention: group medical visits of patients with their own PCP. Group visits include both education and medical care components. Organizational component: tracking of organizational issues in establishing the program of group visits; interviews with key stakeholders to identify barriers and facilitators to implementing the new model of care. Outcome measures: patients' blood pressures (BPs), medication adherence, satisfaction, and health-related quality of life; PCP satisfaction; qualitative analysis of themes from interviews for patient, physician, and medical center factors involved in making organizational changes to encompass group visits.
Findings We exceeded the target enrollment for primary care providers (PCPs) with a total of 16 (11 intervention, 5 control). We enrolled 296 patients; 7 had incomplete baseline data leaving 289 patients: 145 allocated to GVs, 73 control patients of GV-PCPs, and 71 control patients of control PCPs. We have also enrolled an additional 12 staff members for interviews, including the one PCP who did not elect to participate. Study arm comparisons will not be made until the final data collection is complete. In formative evaluations we found that patient medical needs were met in the group setting and that both patients and PCPs were satisfied with the GV format. PCPs and patients have requested that the GVs continue after the study ends. Space for the GVs has been a major barrier particularly in light of ongoing construction in the clinic building.
Status We are now in Step 3 with plans to end the intervention phase at the end of March 2006 and complete final data collection soon thereafter.
Impact Group Medical visits are a new model of health care delivery that hold promise for improving patient access, patient and provider satisfaction, and clinical outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Arm 1 | Other | Behavioral: Group medical visits |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- Subjects include both health care professionals and their patients. The included health care professionals are primary care clinicians practicing at VA Palo Alto who have their own panels of patients for whom they provide primary care. Included patients are patients of these primary care clinicians; the patients must have a diagnosis of hypertension and at least one blood pressure in the previous year that was above guideline-target for that patient, and patient must be approved by the primary care clinician as suitable for a group medical visit.
Key exclusion criteria (1 listed)
- Primary care clinicians with very small patient panels (too small for recruitment of patients for group visits) ae excluded. Patients are excluded by their primary care clinician using clinical judgment; typical reasons for exclusion include terminal illness, dementia that would make patient unable to participate in group discussions. Because primary care clinicians located at main study site do not provide primary care to children, no children will be included in the sample.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Group medical visitsOur intervention aims to develop and implement a model of group medical visits in iterative steps, to evaluate whether group medical visits improve patient adherence to prescribed antihypertensive medications and improve BP control, and to assess patient, physician, and health care system factors involved in successfully making organizational changes to encompass group medical visits. | Behavioural | Arm 1 |
Primary outcome
Change in blood pressure from baseline to endpoint (6, 12 or 18 months depending on how long patient is in study) and comparisons of study arms; change inmedication adherence from baseline to endpoint. Formative evaluation of the program.
Time frame: 6, 12, 18 months
1 secondary outcome
Patient, provider and other staff satisfaction; organizational impact of the group visits program (health care system factors exploratory analyses of utilization)added value of visits beyond 12 months, qualitative data from interviews.
Time frame: 18 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Apr 2015.
- Stanford Community Profiles of Faculty: principal investigator informationLink provided by the sponsor.
Related trials for Hypertension
Active, not recruiting
Digital Reinforcement of Motivational Interviewing Micro-Skills Among Primary Care Healthcare Professionals
Hypertension (Without Type 2 Diabetes Mellitus)
Recruiting
Investigating Vascular Properties of HEMI and SPG Signals in Individuals With or at Risk for Chronic Kidney Disease
Chronic Kidney Disease, Hypertension (HTN)
Recruiting
Trial Phase: Syndemic Adapted Medly Uganda
Mental Health
Not yet recruitingPhase 2/3
An Open-Label Extension Study to Evaluate Inhaled Treprostinil SMI in Participants With Pulmonary Hypertension Associated With Chronic Obstructive Pulmonary Disease (PH-COPD)
Pulmonary Hypertension Associated With Chronic Obstructive Pulmonary Disease
Enrolling by invitation
Testing Implementation Strategies to Support Clinic Fidelity to an Outpatient Hypertension Bundle
Pregnancy Related, Hypertension
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mary K. Goldstein, MD MS principal investigator
VA Palo Alto Health Care System, Palo Alto, CA
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Group medical visits in people with Hypertension, run by US Department of Veterans Affairs at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in blood pressure from baseline to endpoint (6, 12 or 18 months depending on how long patient is in study) and comparisons of study arms; change inmedication adherence from baseline to endpoint. Formative evaluation of the program. (time frame: 6, 12, 18 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Apr 2015.