Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial
Background Emergency department (ED) visits can be opportunities to address uncontrolled hypertension. We sought to compare short‐term blood pressure measures between the Vanderbilt Emergency Room Bundle (VERB) intervention and usual care plus education. Methods and Results We conducted a randomized...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024339 |
| _version_ | 1797786336187383808 |
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| author | Andrew J. Spieker Lyndsay A. Nelson Russell L. Rothman Christianne L. Roumie Sunil Kripalani Joseph Coco Daniel Fabbri Phillip Levy Sean P. Collins Tommy Wang Dandan Liu Candace D. McNaughton |
| author_facet | Andrew J. Spieker Lyndsay A. Nelson Russell L. Rothman Christianne L. Roumie Sunil Kripalani Joseph Coco Daniel Fabbri Phillip Levy Sean P. Collins Tommy Wang Dandan Liu Candace D. McNaughton |
| author_sort | Andrew J. Spieker |
| collection | DOAJ |
| description | Background Emergency department (ED) visits can be opportunities to address uncontrolled hypertension. We sought to compare short‐term blood pressure measures between the Vanderbilt Emergency Room Bundle (VERB) intervention and usual care plus education. Methods and Results We conducted a randomized trial of 206 adult patients with hypertension and elevated systolic blood pressure (SBP) presenting to 2 urban emergency departments in Tennessee, USA. The VERB intervention included educational materials, a brief motivational interview, pillbox, primary care engagement letter, pharmacy resources, and 45 days of informational and reminder text messages. The education arm received a hypertension pamphlet. After 78 participants were enrolled, text messages requested confirmation of receipt. The primary clinical outcome was 30‐day SBP. The median 30‐day SBP was 122 and 126 mm Hg in the VERB and education arms, respectively. We estimated the mean 30‐day SBP to be 3.98 mm Hg lower in the VERB arm (95% CI, −2.44 to 10.4; P=0.22). Among participants enrolled after text messages were adapted, the respective median SBPs were 121 and 130 mm Hg, and we estimated the mean 30‐day SBP to be 8.57 mm Hg lower in the VERB arm (95% CI, 0.98‒16.2; P=0.027). In this subgroup, the median response rate to VERB text messages was 56% (interquartile range, [26%‒80%]). Conclusions This pilot study demonstrated feasibility and found an improvement in SBP for the subgroup for whom interactive messages were featured. Future studies should evaluate the role of interactive text messaging as part of a comprehensive emergency department intervention to improve blood pressure control. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02672787. |
| first_indexed | 2024-03-13T01:07:28Z |
| format | Article |
| id | doaj.art-08c6baf8279e4586bd300be0746b6bc0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T01:07:28Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-08c6baf8279e4586bd300be0746b6bc02023-07-06T05:53:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111510.1161/JAHA.121.024339Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized TrialAndrew J. Spieker0Lyndsay A. Nelson1Russell L. Rothman2Christianne L. Roumie3Sunil Kripalani4Joseph Coco5Daniel Fabbri6Phillip Levy7Sean P. Collins8Tommy Wang9Dandan Liu10Candace D. McNaughton11Department of Biostatistics Vanderbilt University Medical Center Nashville TNDepartment of Medicine Vanderbilt University Medical Center Nashville TNInstitute for Medicine and Public Health Vanderbilt University Medical Center Nashville TNDepartment of Medicine Vanderbilt University Medical Center Nashville TNDepartment of Medicine Vanderbilt University Medical Center Nashville TNDepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TNDepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TNDepartment of Emergency Medicine Wayne State University Detroit MIDepartment of Emergency Medicine Vanderbilt University Medical Center Nashville TNInternal Medicine University of Texas Southwestern Medical Center Dallas TXDepartment of Biostatistics Vanderbilt University Medical Center Nashville TNDepartment of Emergency Medicine Vanderbilt University Medical Center Nashville TNBackground Emergency department (ED) visits can be opportunities to address uncontrolled hypertension. We sought to compare short‐term blood pressure measures between the Vanderbilt Emergency Room Bundle (VERB) intervention and usual care plus education. Methods and Results We conducted a randomized trial of 206 adult patients with hypertension and elevated systolic blood pressure (SBP) presenting to 2 urban emergency departments in Tennessee, USA. The VERB intervention included educational materials, a brief motivational interview, pillbox, primary care engagement letter, pharmacy resources, and 45 days of informational and reminder text messages. The education arm received a hypertension pamphlet. After 78 participants were enrolled, text messages requested confirmation of receipt. The primary clinical outcome was 30‐day SBP. The median 30‐day SBP was 122 and 126 mm Hg in the VERB and education arms, respectively. We estimated the mean 30‐day SBP to be 3.98 mm Hg lower in the VERB arm (95% CI, −2.44 to 10.4; P=0.22). Among participants enrolled after text messages were adapted, the respective median SBPs were 121 and 130 mm Hg, and we estimated the mean 30‐day SBP to be 8.57 mm Hg lower in the VERB arm (95% CI, 0.98‒16.2; P=0.027). In this subgroup, the median response rate to VERB text messages was 56% (interquartile range, [26%‒80%]). Conclusions This pilot study demonstrated feasibility and found an improvement in SBP for the subgroup for whom interactive messages were featured. Future studies should evaluate the role of interactive text messaging as part of a comprehensive emergency department intervention to improve blood pressure control. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02672787.https://www.ahajournals.org/doi/10.1161/JAHA.121.024339emergency carehypertensionmedication adherencemotivational interviewingpatient engagement |
| spellingShingle | Andrew J. Spieker Lyndsay A. Nelson Russell L. Rothman Christianne L. Roumie Sunil Kripalani Joseph Coco Daniel Fabbri Phillip Levy Sean P. Collins Tommy Wang Dandan Liu Candace D. McNaughton Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease emergency care hypertension medication adherence motivational interviewing patient engagement |
| title | Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial |
| title_full | Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial |
| title_fullStr | Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial |
| title_full_unstemmed | Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial |
| title_short | Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial |
| title_sort | feasibility and short term effects of a multi component emergency department blood pressure intervention a pilot randomized trial |
| topic | emergency care hypertension medication adherence motivational interviewing patient engagement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024339 |
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