Rapid Intervention Through Telephone Encounters for Blood Pressure Control by Residents in an Outpatient Resident Clinic

Abstract

Introduction Sixty-seven million Americans have hypertensionthat costs the nation $47.5 billion each year. The aim of this study was to determine if regular phone calls by residents helped achieve better blood pressure control. Methods The study was a randomized open-labeled study in a resident-run outpatient clinic in Rochester, New York. A total of 57 poorly controlled hypertensives in the clinic were divided into two groups. All the patients received scheduled phone calls once every two weeks for a total of 24 weeks. In one group, the medications were adjusted over the phone and the other group was referred to be seen in the clinic for elevated blood pressures. Both the groups were compared to the usual standard of care group. Results Fifty-eight patients were recruited for the trial out of which 53 were used for the final data analysis. Eleven patients completed the trial and had a mean drop of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 28 and 11 mmHg with p < 0.01 and p < 0.03, respectively. Among the patients who did not complete the trial but answered at least one phone call, the mean drop of SBP and DBP was 29 and 8 mmHg with a p < 0.001 and p < 0.008, respectively. When these were compared to the usual standard of care group, the mean drop in SBP was 28.36 (12.36-48.36), 29.85 (11.85-47.85), and 0.76 (8.04-9.56) with a p < 0.02. Conclusions Patients enrolled in the trial had much better blood pressure control compared to the usual standard of care. Residents can take greater ownership of patients to help achieve better blood pressure control. To our knowledge this is the first such study done exclusively by residents in a resident-run clinic.

Keywords: behavioral medicine; hypertension; medication; outpatient department; resident training; telephone.

Figure 1. Flowchart of the study protocol.

Figure 2. Study groups.

Figure 3. Comparison of mean drop in systolic blood pressure in those who completed the trial, did not complete the trial, and standard of care.

Figure 4. Comparison of mean drop in diastolic blood pressure in those who completed the trial, did not complete the trial, and standard of care.

Figure 5. Comparison of mean systolic blood pressure in those who completed the trial and those who did not complete the trial.

Figure 6. Comparison of mean diastolic blood pressure in those who completed the trial and those who did not complete the trial.