Personalized physician learning intervention to improve hypertension control: randomized trial comparing two methods of physician profiling [poster]
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Purpose: Assess the impact of personalized physician learning (PPL) interventions using simulated learning cases to improve control of hypertension and dyslipidemias in primary care settings. Methods: 132 primary care physicians (PCP), with their 6,307 patients with uncontrolled HT and their 20,030 patients with uncontrolled dyslipidemia were cluster randomized to receive: (a) no intervention, (b) PPL-EMR intervention (PCP assigned cases based on patterns of care in the EMR), or (c) PPL-ASSESS intervention (PCP assigned cases based on 4 assessment cases). General and generalized linear mixed models were used to account for clustering and model differences in outcomes across study arms. Results: Among those with uncontrolled HT at baseline, 49.1%, 46.6% and 47.3% (p=0.43) achieved BP targets at follow-up, and among those with uncontrolled dyslipidemia at baseline, 37.5%, 37.3% and 38.1% (p=0.72) achieved LDL targets at follow-up in PPL-EMR, PPL-ASSESS, and the control group, respectively. Although both SBP (p<.001) and lipid (p<.001) values significantly improved during the study period, the group x time interaction term showed no significant differential change in SBP values (p=0.51) or lipid values (p=0.61) across the 3 study arms. No difference in intervention effect was noted when comparing PPL-EMR and the PPL-ASSESS interventions (p=0.47). Conclusion: Two PPL interventions tested in this study did not lead to improved control of hypertension or dyslipidemia in primary care clinics during a mean 14 month follow-up period. This null result may have been due in part to substantial improvement in BP and lipid control in study site patients during the study period.