Evidence map›Paper›PMID 25952653›Full record

Trial reportJournal of general internal medicine2015

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

Karen L Margolis, Stephen E Asche, Anna R Bergdall, Steven P Dehmer, Michael V Maciosek, Rachel A Nyboer, Patrick J O'Connor, Pamala A Pawloski, JoAnn M Sperl-Hillen, Nicole K Trower and 2 more

3 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 31 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 7 pooled it
–field-weighted citation impact
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.

NCT00781365 nacompletednot on this map

Home Blood Pressure Telemonitoring and Case Management to Control Hypertension

TypeinterventionalSponsorHealthPartners InstituteRan2009 to 2012Enrolled450ConditionsHypertensionArmsTelemonitors and pharmacy management
NCT02919033 naunknown statusnot on this mapstarted 2016, after this paper: background citation

A Coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China's Community Hypertension Care: Study Protocol for a Randomized Controlled Trial

TypeinterventionalSponsorXu LeiRan2016 to 2018Enrolled330ConditionsHypertensionArmsUsual care, Self-management, PCTM intervention
NCT04407962 nacompletednot on this mapstarted 2020, after this paper: background citation

PUSHME (Primary Care USage of Health Promoting Messages): A Text Message-based Intervention in Primary Care Patients With Hypertension: a Randomized Controlled Trial

TypeinterventionalSponsorLund UniversityRan2020 to 2023Enrolled400ConditionsHypertension, Cardiovascular Risk FactorArmsSMS group
3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  6. Pharmacist services for non-hospitalised patients.The Cochrane database of systematic reviews · 2018
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Karen L MargolisHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA. karen.l.margolis@healthpartners.com.
Stephen E AscheHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Anna R BergdallHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Steven P DehmerHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Michael V MaciosekHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Rachel A NyboerHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Patrick J O'ConnorHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Pamala A PawloskiHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
JoAnn M Sperl-HillenHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Nicole K TrowerHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Ann D TuckerHealthPartners Institute for Education and Research, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA.
Beverly B GreenGroup Health Research Institute, Seattle, WA, USA.

Funding

Home Blood Pressure Telemonitoring and Case Management to Control HypertensionR01HL090965 · NHLBI · HEALTHPARTNERS INSTITUTE · PI MARGOLIS, KAREN L · 2008 to 2015
$3.3M
NHLBI NIH HHS R01 HL090965
6 · The paper itself

Abstract

backgroundIt is important to understand which components of successful multifaceted interventions are responsible for study outcomes, since some components may be more important contributors to the intervention effect than others.

objectiveWe conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure (BP) after 6 months in a trial to improve hypertension control.

designThe study was a preplanned secondary analysis of a cluster-randomized clinical trial. Eight clinics in an integrated health system were randomized to provide usual care to their patients (n = 222), and eight were randomized to provide a telemonitoring intervention (n = 228).

participantsFour hundred three of 450 trial participants completing the 6-month follow-up visit were included.

interventionsIntervention group participants received home BP telemonitors and transmitted measurements to pharmacists, who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits. MAIN MEASURES: Path analytic models estimated indirect effects of the seven potential mediators of intervention effect (defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months). The potential mediators were change in home BP monitor use, number of BP medication classes, adherence to BP medications, physical activity, salt intake, alcohol use, and weight. KEY

resultsThe difference in change in systolic BP was 11.3 mmHg. The multivariable mediation model explained 47 % (5.3 mmHg) of the intervention effect. Nearly all of this was mediated by two factors: an increase in medication treatment intensity (24 %) and increased home BP monitor use (19 %). The other five factors were not significant mediators, although medication adherence and salt intake improved more in the intervention group than in the usual care group.

conclusionsMost of the explained intervention effect was attributable to the combination of self-monitoring and medication intensification. High adherence at baseline and the relatively low intensity of resources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP.

Indexed as

AgedAlcohol DrinkingAntihypertensive AgentsBlood PressureBlood Pressure Monitoring, AmbulatoryCase ManagementCombined Modality TherapyDrug MonitoringFemaleHumansHypertensionLife StyleMaleMiddle AgedMotor ActivityPrimary Health CareAntihypertensive AgentsSodium Chloride, DietaryBlood pressureCase managementHypertensionMediationRandomized trialTelemonitoring

Identifiers

PMID25952653
PMCPMC4617923

What OpenQuestion holds

Textmetadata
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.