Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol

Julie Gleason-Comstock, Alicia Streater, Joel Ager, Allen Goodman, Aaron Brody, Laura Kivell, Aniruddha Paranjpe, Jasmine Vickers, LynnMarie Mango, Rachelle Dawood, Phillip Levy, Julie Gleason-Comstock, Alicia Streater, Joel Ager, Allen Goodman, Aaron Brody, Laura Kivell, Aniruddha Paranjpe, Jasmine Vickers, LynnMarie Mango, Rachelle Dawood, Phillip Levy

Abstract

Background: Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population.

Methods/design: Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management.

Discussion: The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings.

Trial registration: ClinicalTrials.gov.

Registration number: NCT02069015. Registered February 19, 2014.

Figures

Fig. 1
Fig. 1
Kiosk-based patient education as enhanced discharge: IMB conceptual model
Fig. 2
Fig. 2
Study flow chart
Fig. 3
Fig. 3
Anti- hypertensive regimen. Note: Medications are prescribed in the absence of any contraindications

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