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Trial of usual care for hypertension (touch): An effectiveness study of newly treated hypertension comparing losartan potassium and “Usual care” in a managed care setting
AJH-APRIL 19.95-li'OL.8, NO.4, PART 2
POSTERS: Health CareMimagement, Economics, and Outcome 79A
F5
F6
EFFEcrS or INCOME, l~SURANCE, AND SOURCE OF CARS OR BYPERHNSIW CARB. E Hoy, S Sartman, l'f.B. H2i£*. Divisions of General Internal Medicine and Nephrology, University of Maryland School of Medicine, Saltimore, MD.
TEACHING. AND ASSESSING BLOOD PRESSURE MEASUREMENT SKILLS FOR MEDICAL STUDENTS. Grim eM', Grim CE." CR Drew Unlv. & UCLA, Los Angeles, LA
Purpose. To examine the relatlonship between income, hoalth insurance, and usual source of care characteristics and screening and management of hypertension. Methods. Data sourCSf 198' National Medical Expenditure survey. Adult survey respondents constitute _ sample representative of the total adult non-institutionalized U.S. population. Screening, follow-up care, and pharmacologic treatment for hypertension were examined among low income individuals, the uninsured, thoee without a usual sourco of c~re place, and those without a particular usual source of care physician. Results. After adjusting for patient demo9ra~hic charactaristics and health status, the uninsured were about 1.5 times less likely to receive screening, folloH-UP care, and pharmacologic treatment for hypertension. Similarly, individuale without a usual source of care place were about 3.5 times less likely and those without a particuLar usual sou~ce of care physician were about 2. S tim9s less likely to receive hypertensive eal:~. Ineoma did not have an independent effect on recel~t of hypertensive care. conclusions. Lack of health insurance and of a usual source of care are barriers to hypertensive care. Policies that increase access to health insurance or to usual source of care physiciane may enable more individuals to achieve control of hypertension.
Key Words:
Income, Insurance, Source of Care, HYl""ertension
FB
F7 PROGNOSTIC VALUE OF EXERCISE BLOOD PRESSURE IN HYPERTENSIVE MEN AND WOMEN. P Gosse·, J Fawaz, B Oaubigny, P Ansoborlo, J Clementy. Hopital Saint Andre, CHU Bordeaux, France.
We assessed the outcome of280 mild tomoderate uncomplicated hypertensive patients (190 males, 90 females) who underwent a bicycle exercise test more than 10years ago. Exercise test was performed with an initial load of30W with Increments of30W in men and 20W (n women every 3 minutes until exhaustion. Indirect 8P was measured bytrained nurses every 3' and at peak exercIse. During the follow-up time , 55patients suffereli at least one fatal or non fatal cardiovascular event. Using the Cox regression model age (mean±SD=42±13 years), office systolic and diastolic BP(160±24/97±14mmHg), peak exercise systolic and dIastolic BP (213±321108±22 mmHg), total plasma cholesterollevel(5.4±1.1 mmolell) were significantly related to cardiovascular complications. Apart from age, peak exercise systolic BP demonstrated the strongest association with complications. This association remained significant when age and office BP were taken into account. Age adjusted relative hazard rate for peak exercise systolic BP was 1.013 (1.005-1.022 confidence interval, p
KeyWords:
outcome
and Mad. College of Wisconsin, Milwaukee, WI. We esl/mate a physician makes medical decisions on500,000 blood pressure (BP) measurements dUring a career. II these BPs are inaccurate thousands of patients wlif be harmed. Research hAs repeatedly demonstrated that 8P Is rarely measured acccrding to gUidelines. It Is critical that physicians master the skill of accurate measurement and maintaIn this skill. If they do notmeasure 81' themselves they nead to understand why and how to establish a program to assure that measurements upon which they make decisions are performed properly to minimize harm totheir panents, Aspart or our NIH Preventive Cardiology Award we revJewed the :rainlng of medical students at UCLA and Drew for BP measurement. Most students did not own a 8P CUff. ,'he ave ~age time spent learning measurement on patients was less than 10 minutes and surveys 01 knOWledge and one 0'1 one observations 01 skills and performance of blood pressure by students were woefully Inadequate. To improve the teaching to mastery 01 this critical docloring skill we evaluated 2, 4 and 6 hrvideo tutored teaching programs and found them Inadequate. A 8 hour curriculum including 2 hours of "homework" was tested in 150 medical students during the second week of Medical School lind demonstrated mastery of the knowledge, skills and performance of proper technique assessed will, a pre and post written test. return demonstration of proper techniques and successfUl completion of a standardized video test ( ±2 mm Hg In 60% of the examples) could be a ompllshed by most students, but 10% required additional til lid . They also learned how to check nor.·mercury devices against the gold standard mercury device and to assess others in proper technique. When students used proper technique (Juring c ~nical perceptorships they were frequently given tho impl'Jssion that·real doctors" don't have time to take blood pressure correctly and thaI they took too long. Ournext task Isto train preceptors and their office staff how to do blood pressure c:orrectly so student's newly acquired correct knowledQ9 and skills are notcounteracted. Key Wolds: Teaching currtcufum, blood pressure measurement. quality control, medical decision making
ext3rc;se test, blood pressure,
TRIAL OF USUAL CARE FOR HYPERTENSION (TOUCH): AN EFFECTiVENESS STIJDY OF NEWLY TREATrD HYPERTENSION COMPARING LOSARTAN POTASSIIJM AND "USUALCARE" IN A MANAGED CARE SElTING. JM Edelman. LPGazdick, RS Epstein, IT Flaherty. Merck &. Co., Inc., West Point. PA. The effectiveness and cost-effectiveness of treating newly diagnosed hypertensive patients with losartan potassium, an angiotensin II receptor antagonist. is being assessed through a prospective randomized two period trialconducted at 10 managed care (MC) organizations throughout the United States. Ateach Me siteup to 12 treating physician investigators (TI) will treat hypertcnisvc patients with lossrtan to gain familiarity with the use of the drug. Following this pilot period. each TI will be randomly assigned to administer medical care to previous1r untreated hypcrtcnsh'e patiellls Idiastolic blood pressure (OSP) 95 to 115 mmHg] that includes currently approved anti-hypertensive medications ("usual care" arm) or losartan potassium plus additional hydrochlorothiazide if needed (losartan arm). Patients will be recruited from the Me community and evaluated for participation in thestudy byan adm'-~::tr;llive physician investigator (AI). Qualified patients will be randomly assigned to a Tl for initiation of antihypertensive treatment. Initial and final visits (after 6 months) with the TI ale required. All other visits arc determined bytheTI accordingto thepatient's response to therapy and practice guidelines of the MC organization. Mean truugh (end of dosing interval) sitting diastolic blood pressure will be assessed every two months bya visiting nurse in the patient's home using a Hawksley Randomized Zero (RZ) sphygmomanometer, Allvisiting nurses will be certified in AHA standard blood pressure measurement technique using th.. RZ device, and will he blinded to both treatment regimen and blood pressure readings. Quality of lifewill be assessed by selfadministered questionnaire, Medical resource utilization will be collected byconcurrent chartreview. Patient safety will be monitored ty the AIat each site, Medieation C'lr both arms of the study \~iJ( be provided Iree of charge through a study pharmacy. The primary outcome of interest is the percent of patients per physician at goal (defined as DDP c 90 mmHg or ~ 10mmHg dropfrom baseline) after 6 months. In addition, the percentage of patients whodiscontinue or snitch initial antihypertenslve therapy. thecost and cost-effectiveness of hypertension-related office visits and total hypertension-related resource usc, andquality oflife will becompared between groups.
Key Words: Hypcnension, Losartan potassium, managed health care. cost-effectiveness
POSTERS: Health CareMimagement, Economics, and Outcome 79A
F5
F6
EFFEcrS or INCOME, l~SURANCE, AND SOURCE OF CARS OR BYPERHNSIW CARB. E Hoy, S Sartman, l'f.B. H2i£*. Divisions of General Internal Medicine and Nephrology, University of Maryland School of Medicine, Saltimore, MD.
TEACHING. AND ASSESSING BLOOD PRESSURE MEASUREMENT SKILLS FOR MEDICAL STUDENTS. Grim eM', Grim CE." CR Drew Unlv. & UCLA, Los Angeles, LA
Purpose. To examine the relatlonship between income, hoalth insurance, and usual source of care characteristics and screening and management of hypertension. Methods. Data sourCSf 198' National Medical Expenditure survey. Adult survey respondents constitute _ sample representative of the total adult non-institutionalized U.S. population. Screening, follow-up care, and pharmacologic treatment for hypertension were examined among low income individuals, the uninsured, thoee without a usual sourco of c~re place, and those without a particular usual source of care physician. Results. After adjusting for patient demo9ra~hic charactaristics and health status, the uninsured were about 1.5 times less likely to receive screening, folloH-UP care, and pharmacologic treatment for hypertension. Similarly, individuale without a usual source of care place were about 3.5 times less likely and those without a particuLar usual sou~ce of care physician were about 2. S tim9s less likely to receive hypertensive eal:~. Ineoma did not have an independent effect on recel~t of hypertensive care. conclusions. Lack of health insurance and of a usual source of care are barriers to hypertensive care. Policies that increase access to health insurance or to usual source of care physiciane may enable more individuals to achieve control of hypertension.
Key Words:
Income, Insurance, Source of Care, HYl""ertension
FB
F7 PROGNOSTIC VALUE OF EXERCISE BLOOD PRESSURE IN HYPERTENSIVE MEN AND WOMEN. P Gosse·, J Fawaz, B Oaubigny, P Ansoborlo, J Clementy. Hopital Saint Andre, CHU Bordeaux, France.
We assessed the outcome of280 mild tomoderate uncomplicated hypertensive patients (190 males, 90 females) who underwent a bicycle exercise test more than 10years ago. Exercise test was performed with an initial load of30W with Increments of30W in men and 20W (n women every 3 minutes until exhaustion. Indirect 8P was measured bytrained nurses every 3' and at peak exercIse. During the follow-up time , 55patients suffereli at least one fatal or non fatal cardiovascular event. Using the Cox regression model age (mean±SD=42±13 years), office systolic and diastolic BP(160±24/97±14mmHg), peak exercise systolic and dIastolic BP (213±321108±22 mmHg), total plasma cholesterollevel(5.4±1.1 mmolell) were significantly related to cardiovascular complications. Apart from age, peak exercise systolic BP demonstrated the strongest association with complications. This association remained significant when age and office BP were taken into account. Age adjusted relative hazard rate for peak exercise systolic BP was 1.013 (1.005-1.022 confidence interval, p
KeyWords:
outcome
and Mad. College of Wisconsin, Milwaukee, WI. We esl/mate a physician makes medical decisions on500,000 blood pressure (BP) measurements dUring a career. II these BPs are inaccurate thousands of patients wlif be harmed. Research hAs repeatedly demonstrated that 8P Is rarely measured acccrding to gUidelines. It Is critical that physicians master the skill of accurate measurement and maintaIn this skill. If they do notmeasure 81' themselves they nead to understand why and how to establish a program to assure that measurements upon which they make decisions are performed properly to minimize harm totheir panents, Aspart or our NIH Preventive Cardiology Award we revJewed the :rainlng of medical students at UCLA and Drew for BP measurement. Most students did not own a 8P CUff. ,'he ave ~age time spent learning measurement on patients was less than 10 minutes and surveys 01 knOWledge and one 0'1 one observations 01 skills and performance of blood pressure by students were woefully Inadequate. To improve the teaching to mastery 01 this critical docloring skill we evaluated 2, 4 and 6 hrvideo tutored teaching programs and found them Inadequate. A 8 hour curriculum including 2 hours of "homework" was tested in 150 medical students during the second week of Medical School lind demonstrated mastery of the knowledge, skills and performance of proper technique assessed will, a pre and post written test. return demonstration of proper techniques and successfUl completion of a standardized video test ( ±2 mm Hg In 60% of the examples) could be a ompllshed by most students, but 10% required additional til lid . They also learned how to check nor.·mercury devices against the gold standard mercury device and to assess others in proper technique. When students used proper technique (Juring c ~nical perceptorships they were frequently given tho impl'Jssion that·real doctors" don't have time to take blood pressure correctly and thaI they took too long. Ournext task Isto train preceptors and their office staff how to do blood pressure c:orrectly so student's newly acquired correct knowledQ9 and skills are notcounteracted. Key Wolds: Teaching currtcufum, blood pressure measurement. quality control, medical decision making
ext3rc;se test, blood pressure,
TRIAL OF USUAL CARE FOR HYPERTENSION (TOUCH): AN EFFECTiVENESS STIJDY OF NEWLY TREATrD HYPERTENSION COMPARING LOSARTAN POTASSIIJM AND "USUALCARE" IN A MANAGED CARE SElTING. JM Edelman. LPGazdick, RS Epstein, IT Flaherty. Merck &. Co., Inc., West Point. PA. The effectiveness and cost-effectiveness of treating newly diagnosed hypertensive patients with losartan potassium, an angiotensin II receptor antagonist. is being assessed through a prospective randomized two period trialconducted at 10 managed care (MC) organizations throughout the United States. Ateach Me siteup to 12 treating physician investigators (TI) will treat hypertcnisvc patients with lossrtan to gain familiarity with the use of the drug. Following this pilot period. each TI will be randomly assigned to administer medical care to previous1r untreated hypcrtcnsh'e patiellls Idiastolic blood pressure (OSP) 95 to 115 mmHg] that includes currently approved anti-hypertensive medications ("usual care" arm) or losartan potassium plus additional hydrochlorothiazide if needed (losartan arm). Patients will be recruited from the Me community and evaluated for participation in thestudy byan adm'-~::tr;llive physician investigator (AI). Qualified patients will be randomly assigned to a Tl for initiation of antihypertensive treatment. Initial and final visits (after 6 months) with the TI ale required. All other visits arc determined bytheTI accordingto thepatient's response to therapy and practice guidelines of the MC organization. Mean truugh (end of dosing interval) sitting diastolic blood pressure will be assessed every two months bya visiting nurse in the patient's home using a Hawksley Randomized Zero (RZ) sphygmomanometer, Allvisiting nurses will be certified in AHA standard blood pressure measurement technique using th.. RZ device, and will he blinded to both treatment regimen and blood pressure readings. Quality of lifewill be assessed by selfadministered questionnaire, Medical resource utilization will be collected byconcurrent chartreview. Patient safety will be monitored ty the AIat each site, Medieation C'lr both arms of the study \~iJ( be provided Iree of charge through a study pharmacy. The primary outcome of interest is the percent of patients per physician at goal (defined as DDP c 90 mmHg or ~ 10mmHg dropfrom baseline) after 6 months. In addition, the percentage of patients whodiscontinue or snitch initial antihypertenslve therapy. thecost and cost-effectiveness of hypertension-related office visits and total hypertension-related resource usc, andquality oflife will becompared between groups.
Key Words: Hypcnension, Losartan potassium, managed health care. cost-effectiveness