Evidence map›Paper›PMID 22570370›Full record

Trial reportCirculation2012

Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial.

Michele Heisler, Timothy P Hofer, Julie A Schmittdiel, Joe V Selby, Mandi L Klamerus, Hayden B Bosworth, Martin Bermann, Eve A Kerr

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00495794 (Adherence and Intensification of Medications), which is not on this map. Cited by 67 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 15 pooled it
9.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00495794 nacompletednot on this map

Adherence and Intensification of Medications: A Population-Based Clinical Pharmacists Implementation Study Among Hypertensive Diabetes Patients

TypeinterventionalSponsorUS Department of Veterans AffairsRan2008 to 2012Enrolled4,622ConditionsDiabetes, HypertensionArmsClinical pharmacist-based intervention
3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 15 syntheses or guidelines pooled it, 128 citations in OpenAlex.

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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Michele HeislerVA Center for Clinical Management Research (152), 2215 Fuller Rd, PO Box 130170, Ann Arbor, MI 48113-0170, USA. mheisler@umich.edu
Timothy P Hofer
Julie A Schmittdiel
Joe V Selby
Mandi L Klamerus
Hayden B Bosworth
Martin Bermann
Eve A Kerr
VA Center for Clinical Management Research · USKaiser Permanente · USPatient-Centered Outcomes Research Institute · USDurham VA Medical Center · US

Funding

Research BaseP30DK092926 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MARY ELLEN MICHELE HEISLER, ADESUWA B OLOMU · 2011 to 2026
$10.0M
Improving Adherence and Intensification of Medications Among Diabetes PatientsR18DK076622 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI KERR, EVE A · 2007 to 2010
$2.1M
NIDDK NIH HHS 5 R18 DK076622NIDDK NIH HHS P30 DK092926NIDDK NIH HHS R18 DK076622
6 · The paper itself

Abstract

backgroundEven in high-performing health systems, some patients with diabetes mellitus have poor blood pressure (BP) control because of poor medication adherence and lack of medication intensification. We examined whether the Adherence and Intensification of Medications intervention, a pharmacist-led intervention combining elements found in efficacy studies to lower BP, improved BP among patients with diabetes mellitus with persistent hypertension and poor refill adherence or insufficient medication intensification in 2 high-performing health systems. METHODS AND

resultsWe conducted a prospective, multisite cluster randomized pragmatic trial with randomization of 16 primary care teams at 5 medical centers (3 Veterans Affairs and 2 Kaiser Permanente) to the Adherence and Intensification of Medications intervention or usual care. The primary outcome was relative change in systolic BP (SBP), comparing 1797 intervention with 2303 control team patients, from 6 months preceding to 6 months after the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. The mean SBP decrease from 6 months before to 6 months after the intervention period was ≈9 mm Hg in both arms. Mean SBPs of eligible intervention patients were 2.4 mm Hg lower (95% CI: -3.4 to -1.5; P<0.001) immediately after the intervention than those achieved by control patients.

conclusionsThe Adherence and Intensification of Medications program more rapidly lowered SBPs among intervention patients, but usual-care patients achieved equally low SBP levels by 6 months after the intervention period. These findings show the importance of evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings. CLINICAL

trial registrationURL: http://clinicaltrials.gov. Unique identifier: NCT00495794.

Indexed as

Medication AdherenceAgedAntihypertensive AgentsBlood PressureCounselingDiabetes ComplicationsFemaleFollow-Up StudiesHealth Maintenance OrganizationsHumansHypertensionHypoglycemic AgentsMaleMiddle AgedPatient Care TeamPharmacistsAntihypertensive AgentsHypoglycemic Agents

Identifiers

PMID22570370
PMCPMC3999872
OpenAlexW2028121958

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.