Skip to main content
SpringerLink
Log in

Disease Management for Hypertension

A Pilot Cluster Randomized Trial of 67 Australian General Practices

  • Original Research Article
  • Published:
Disease Management & Health Outcomes

Abstract

Objectives

We aimed to assess the feasibility of implementing, within Australian general practice, an innovative disease management program for hypertension. The central platform of this program is an information communication technology package for risk assessment and management, access to a dietitian commissioned by the program and a tailored set of audiovisual and written material.

Methods

We carried out a pilot cluster randomized controlled trial (stratified for rurality) of 67 general practices (including 371 patients) across two Australian states. Our primary hypothesis was that a disease management program would improve the cardiovascular risk score in patients with mild to moderate hypertension, compared with that of patients being treated according to current clinical practice. Analysis was by intention to treat.

Results

There was a borderline significant favorable treatment effect of the disease management program on the cardiovascular risk score of 4.6 percentage points (95% CI -9.7, 0.6) (theoretical range: 0–100%) at 6 months. At 12 months there was a non-statistically significant effect of approximately 2 percentage points. The proportion of patients achieving the target blood pressure of ≤130/85mm Hg was modest at between 20% and 30%. There was no treatment effect of the disease management program on this outcome at 6 months and a treatment effect favoring the control group was seen at 12 months (difference = −11.6%; 95% CI —21.1, −2.1). There was a modest short-term treatment effect in favour of the disease management program in terms of change in blood pressure from baseline. At 12 months follow-up, 70% of general practitioners were still accessing the program’s CD-ROM and improvements were noted for five of nine items measuring their satisfaction in relation to the provision of hypertension care. A treatment effect was found for 5 of 16 items on the patient satisfaction questionnaire at 6 months and 12 of 16 items at 12 months.

Conclusions

Disease management for hypertension incorporating information communication technologies is pragmatic in general practice and results in modest short-term health gains. More research is required to ensure feasibility over a longer period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Table I
Table II
Table III

Similar content being viewed by others

References

  1. Hunter DJ. Disease management: has it a future? BMJ 2000; 320: 530

    Article  PubMed  CAS  Google Scholar 

  2. Hunter DJ, Fairfield G. Managed care: disease management. BMJ 1997; 315: 50–3

    Article  PubMed  CAS  Google Scholar 

  3. Bodenheimer T. Disease management in the American market. BMJ 2000; 320: 563–6

    Article  PubMed  CAS  Google Scholar 

  4. Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360(9343): 1347–60

    Article  PubMed  Google Scholar 

  5. Epstein RS, Sherwood LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med 1996; 124: 832–42

    PubMed  CAS  Google Scholar 

  6. Weingarten SR, Henning JM, Badamgarav E, et al. Interventions used in disease management programmes for patients with chronic illness: which ones work? Meta-analysis of published reports. BMJ 2002; 325: 925–32

    Article  PubMed  Google Scholar 

  7. World Health Organization. Integrated management of cardiovascular risk: report of a WHO Meeting. Geneva: World Health Organization, 2002

    Google Scholar 

  8. Turnbull DA, Mensforth H, Beilby JJ, et al. An empirical model for the development of disease management programs in general practice. Dis Manage Health Outcomes 2002; 10: 723–9

    Article  Google Scholar 

  9. Wilkinson D, McElroy H, Beilby J, et al. Uptake of health assessments, care plans and case conferences by general practitioners through the Enhanced Primary Care program between November 1999 and October 2001. Aust Health Rev 2002; 25: 1–11

    Article  PubMed  Google Scholar 

  10. Bollen MD. Recent changes in Australian general practice. Med J Aust 1996; 164: 212–5

    PubMed  CAS  Google Scholar 

  11. Donner A, Klar N. Design and analysis of cluster randomization trials in health research. London: Arnold, 2000

    Google Scholar 

  12. Guidelines Subcommittee of the World Health Organization — International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee. 1999 World Health Organization — International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17: 151–83

    Google Scholar 

  13. Wing LMH, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003; 348: 583–92

    Article  PubMed  CAS  Google Scholar 

  14. Fogarty JS. Reactance theory and patient non-compliance. Soc Sci Med 1997; 45: 1277–88

    Article  PubMed  CAS  Google Scholar 

  15. van der Merwe Haug D. Utilization and interaction: an exploration of processes in a new disease management program for hypertension [masters thesis]. Adelaide (SA): Department of Psychology, University of Adelaide, 2002

    Google Scholar 

  16. Kannel WB, Neaton JD, Wentworth D, et al. Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT Multiple Risk Factor Intervention Trial. Am Heart J 1986; 112: 825–36

    Article  PubMed  CAS  Google Scholar 

  17. National Heart Foundation of Australia. Risk Factor Prevalence Study (No. 3). Canberra: National Heart Foundation of Australia and Australian Institute of Health, 1989

    Google Scholar 

  18. Wing LMH, Reid CM, Ryan P, et al. Second Australian National Blood Pressure Study (ANBP2). Australian comparative outcome trial of ACE inhibitor and diuretic-based treatment of hypertension in the elderly. Clin Exp Physiol 1997; 19(5–6): 779–91

    CAS  Google Scholar 

  19. Huxley PJ. The GSQ Pilot Study: technical details. Manchester: Manchester University Social Work Research Unit, Department of Psychiatry, 1998

    Google Scholar 

  20. Department of Epidemiology and Preventive Medicine. Take heart assessment program. Melbourne (VIC): Monash University, 2001

    Google Scholar 

  21. Montgomery AA, Fahey T. A systematic review of the use of computers in the management of hypertension. J Epidemiol Community Health 1998; 52: 520–5

    Article  PubMed  CAS  Google Scholar 

  22. World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: World Health Organization, 2002

    Google Scholar 

  23. Wagner EH. The role of patient care teams in chronic disease management. BMJ 2000; 320: 569–72

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Funding for this study was provided by AstraZeneca Pty Ltd, Aventis Pharma Pty Ltd, Bayer Australia Ltd, and Pfizer Pty Ltd. The following roles were undertaken by the authors in conjunction with Data Management Analysis Centre at the Departments of General Practice and Public Health, the University of Adelaide: study design, data collection, analysis and interpretation, and preparation of the manuscript. The supporting sources did not control or influence the decision to submit the manuscript for publication. The views expressed in this paper are those of the authors.

The authors thank all of the study participants, including the patients, general practitioners and dietitians. Sponsor representatives on the ADAGE Management Committee are: Ms Alison Van Nooten, Clinical Projects Manager, AstraZeneca Pty Ltd; Dr Christine Smith, Health Outcomes Stream Manager, Pfizer Australia Pty Ltd; Ms Susan Hopkins, Medical Manager, Aventis Pharma Pty Ltd; and Dr Jeff Hassall, Medical Director, Bayer Australia Ltd. The data for this study were managed and analyzed by the Data Management Analysis Centre at the Departments of General Practice and Public Health, the University of Adelaide. The authors wish to thank Dr Greg Pearce for his contribution to the conceptualization of the ADAGE program and its evaluation. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Departments of General Practice and Psychology, The University of Adelaide, North Tce, Adelaide, South Australia, 5005, Australia

    Deborah A. Turnbull (Chair of Psychology), Justin J. Beilby, Tahereh Ziaian & Farooq Qureshi

  2. Department of General Practice, Monash University, East Bentleigh, Victoria, Australia

    Mark Nelson

  3. Department of Clinical and Experimental Pharmacology, The University of Adelaide, Adelaide, South Australia, Australia

    Anne L. Tonkin

  4. Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia

    John E. Marley

Authors
  1. Deborah A. Turnbull
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin J. Beilby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tahereh Ziaian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Farooq Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne L. Tonkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John E. Marley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah A. Turnbull.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turnbull, D.A., Beilby, J.J., Ziaian, T. et al. Disease Management for Hypertension. Dis-Manage-Health-Outcomes 14, 27–35 (2006). https://doi.org/10.2165/00115677-200614010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200614010-00004

Keywords

Search

Navigation