Is a shared decision-making approach effective in improving hypertension management?

Abstract

The authors assessed whether patient empowerment in the management of hypertension improved more with the practice of shared decision making (SDM) than by education programs. In a prospective controlled clinical study, 15 general practitioners in Nuremberg, Germany who were specially trained to conduct SDM consultations participated in a 12-month study. Hypertensive patients (N=86) were included; N=40 were in the SDM group and N=46 were in the control group, if blood pressures were > or = 135 / 85 mm Hg (self measurement) and patients had no signs of cardiovascular complications or severe hypertension. All participants in the SDM group and the control group were enrolled in an education program on hypertension in small groups. The SDM group participants also had 4 special consultations to share medical decisions. The main outcome measures were the effect of SDM on blood pressure control. After 1 year blood pressure had decreased in all participants: Delta-9.26 +/- 10.2 mm Hg/Delta-5.33 +/- 9.5 mm Hg in the SDM group (P<0.001) compared to Delta-6.0 +/- 11.8 mm Hg/Delta-3.0 +/- 8.3 mm Hg in the control group. There was no significant difference between the 2 groups. The study group practiced more SDM than controls, but blood pressure control was not significantly better. Patient empowerment by means of an education program in small groups and creating awareness of hypertensive disease helps to improve the outcome of hypertension treatment. SDM, however, did not improve management when compared to an education program, which is much easier to implement in general practice.

Figure 1

Systolic as well as diastolic blood pressure (BP) were lowered during the study to the same extent in patients practicing shared decision making (SDM) and in the patients enrolled in the education program on hypertension (baseline, after 1 year). SD indicates standard deviation.

Figure 2

The results concerning blood pressure decreases cannot be attributed to a different desire for shared decision making (SDM) expressed at baseline in the 2 groups since the respective questionnaire (Autonomy Preference Index) revealed identical results at the beginning and after 1 year.

Figure 3

The results of the shared decision making (SDM) sum score on actually practiced SDM exhibited in both groups significantly increased, but the control group did not reach the score of the study group after 1 year.