Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial
Abstract OBJECTIVE To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high‐risk population. METHODS A hypertension emergency department intervention aimed at decreasing disparities (AHE...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-04-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12386 |
| _version_ | 1826574956425641984 |
|---|---|
| author | Heather Prendergast Marina Del Rios Ramon Durazo‐Arvizu Sandra Escobar‐Schulz Sara Heinert Maya Jackson Renee Petzel Gimbar Martha Daviglus Brenda Lara Shaveta Khosla |
| author_facet | Heather Prendergast Marina Del Rios Ramon Durazo‐Arvizu Sandra Escobar‐Schulz Sara Heinert Maya Jackson Renee Petzel Gimbar Martha Daviglus Brenda Lara Shaveta Khosla |
| author_sort | Heather Prendergast |
| collection | DOAJ |
| description | Abstract OBJECTIVE To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high‐risk population. METHODS A hypertension emergency department intervention aimed at decreasing disparities (AHEAD2) is a 3‐arm, single‐site randomized pilot trial for feasibility in an urban academic ED. A total of 150 predominantly ethnic minorities with no primary care provider and severely elevated blood pressure (BP) (≥160/100 mm Hg) were enrolled over 10 months. Participants were randomized into 1 of 3 study arms: (1) enhanced usual care (EUC), (2) ED‐initiated screening, brief intervention, and referral for treatment (ED‐SBIRT), or (3) ED‐ SBIRT plus a 48–72 hours post‐acute care hypertension transition clinic (ED‐SBIRT+PACHT‐c). Primary outcomes were change in systolic and diastolic BP (SBP and DBP) from baseline to 9 months. Secondary outcomes were BP control (BP <140/90 mm Hg), changes in hypertension knowledge, medication adherence, and limited bedside echocardiogram (LBE) findings. RESULTS SBP reduction from baseline to month 9 was −26.8 (95% confidence interval [CI]: −32.8, −20.7) mm Hg for ED‐SBIRT, −23.4 (95% CI: −29.5, −17.3) mm Hg for ED‐SBIRT+PACHT‐c, and −18.9 (95% CI: −24.9, −12.9) mm Hg for EUC. DBP decreased by −12.5 (95% CI: −16.1, −9.0) mm Hg for ED‐SBIRT, −11.3 (95% CI: −14.8, −7.7) mm Hg for ED‐SBIRT+PACHT‐c, and −8.4 (95% CI: −11.9, −4.9) mm Hg for EUC. A multicomponent intervention compared with EUC resulted in SBP decrease of −7.9 mm Hg (95% CI: −16.4, 0.6). At 9 months, hypertension was controlled for 29.3% (95% CI: 20.3, 38.3) of intervention and 23.5% (95% CI: 11.9, 35.2) of EUC participants. All groups saw improvements in hypertension knowledge, medication adherence, and LBEs, with greater improvements in intervention groups. CONCLUSIONS The study findings suggest that a multicomponent intervention comprising of ED education and empowerment coupled with early risk assessment may help improve BP in a high‐risk population. |
| first_indexed | 2024-12-24T04:22:00Z |
| format | Article |
| id | doaj.art-66c8a8080b5c4f35bcb96ea918df6137 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2025-03-14T13:07:02Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-66c8a8080b5c4f35bcb96ea918df61372025-03-02T00:49:35ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-04-0122n/an/a10.1002/emp2.12386Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trialHeather Prendergast0Marina Del Rios1Ramon Durazo‐Arvizu2Sandra Escobar‐Schulz3Sara Heinert4Maya Jackson5Renee Petzel Gimbar6Martha Daviglus7Brenda Lara8Shaveta Khosla9Department of Emergency Medicine University of Illinois at Chicago Chicago Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USAPublic Health Sciences Loyola University Chicago Maywood Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USACollege of Pharmacy University of Illinois at Chicago Chicago Illinois USAInstitute for Minority Health Research University of Illinois at Chicago Chicago Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USADepartment of Emergency Medicine University of Illinois at Chicago Chicago Illinois USAAbstract OBJECTIVE To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high‐risk population. METHODS A hypertension emergency department intervention aimed at decreasing disparities (AHEAD2) is a 3‐arm, single‐site randomized pilot trial for feasibility in an urban academic ED. A total of 150 predominantly ethnic minorities with no primary care provider and severely elevated blood pressure (BP) (≥160/100 mm Hg) were enrolled over 10 months. Participants were randomized into 1 of 3 study arms: (1) enhanced usual care (EUC), (2) ED‐initiated screening, brief intervention, and referral for treatment (ED‐SBIRT), or (3) ED‐ SBIRT plus a 48–72 hours post‐acute care hypertension transition clinic (ED‐SBIRT+PACHT‐c). Primary outcomes were change in systolic and diastolic BP (SBP and DBP) from baseline to 9 months. Secondary outcomes were BP control (BP <140/90 mm Hg), changes in hypertension knowledge, medication adherence, and limited bedside echocardiogram (LBE) findings. RESULTS SBP reduction from baseline to month 9 was −26.8 (95% confidence interval [CI]: −32.8, −20.7) mm Hg for ED‐SBIRT, −23.4 (95% CI: −29.5, −17.3) mm Hg for ED‐SBIRT+PACHT‐c, and −18.9 (95% CI: −24.9, −12.9) mm Hg for EUC. DBP decreased by −12.5 (95% CI: −16.1, −9.0) mm Hg for ED‐SBIRT, −11.3 (95% CI: −14.8, −7.7) mm Hg for ED‐SBIRT+PACHT‐c, and −8.4 (95% CI: −11.9, −4.9) mm Hg for EUC. A multicomponent intervention compared with EUC resulted in SBP decrease of −7.9 mm Hg (95% CI: −16.4, 0.6). At 9 months, hypertension was controlled for 29.3% (95% CI: 20.3, 38.3) of intervention and 23.5% (95% CI: 11.9, 35.2) of EUC participants. All groups saw improvements in hypertension knowledge, medication adherence, and LBEs, with greater improvements in intervention groups. CONCLUSIONS The study findings suggest that a multicomponent intervention comprising of ED education and empowerment coupled with early risk assessment may help improve BP in a high‐risk population.https://doi.org/10.1002/emp2.12386emergency departmentminoritypilot studyuncontrolled hypertension |
| spellingShingle | Heather Prendergast Marina Del Rios Ramon Durazo‐Arvizu Sandra Escobar‐Schulz Sara Heinert Maya Jackson Renee Petzel Gimbar Martha Daviglus Brenda Lara Shaveta Khosla Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial Journal of the American College of Emergency Physicians Open emergency department minority pilot study uncontrolled hypertension |
| title | Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial |
| title_full | Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial |
| title_fullStr | Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial |
| title_full_unstemmed | Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial |
| title_short | Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial |
| title_sort | effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population the ahead2 randomized clinical pilot trial |
| topic | emergency department minority pilot study uncontrolled hypertension |
| url | https://doi.org/10.1002/emp2.12386 |
| work_keys_str_mv | AT heatherprendergast effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT marinadelrios effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT ramondurazoarvizu effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT sandraescobarschulz effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT saraheinert effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT mayajackson effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT reneepetzelgimbar effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT marthadaviglus effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT brendalara effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial AT shavetakhosla effectofanemergencydepartmenteducationandempowermentinterventiononuncontrolledhypertensioninapredominatelyminoritypopulationtheahead2randomizedclinicalpilottrial |