Incorporating Patients’ Social Determinants of Health into Hypertension and Depression Care: A Pilot Randomized Controlled Trial
The objective of this study was to carry out a randomized controlled pilot trial to test the effectiveness of an integrated intervention for hypertension and depression incorporating patients’ social determinants of health (enhanced intervention) versus an integrated intervention alone (basic intervention). In all, 54 patients were randomized. An electronic monitor was used to measure blood pressure, and the nine-item Patient Health Questionnaire (PHQ-9) assessed depressive symptoms. Patients in the enhanced intervention had a significantly improved PHQ-9 mean change from baseline in comparison with patients in the basic intervention group at 12 weeks (p = 0.024). Patients in the enhanced intervention had a significantly improved systolic and diastolic blood pressure mean change from baseline in comparison with patients in the basic intervention group at 12 weeks (p = 0.003 and p = 0.019, respectively). Our pilot trial results indicate integrated care management that addresses the social determinants of health for patients with hypertension and depression may be effective.
KeywordsPrimary health care Hypertension Unmet needs Intervention Depression
This study was supported by Agency for Healthcare Research and Quality (Grant No. K18 HS23445).
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interests.
- Alcantara, C., Edmondson, D., Moise, N., Oyola, D., Hiti, D., & Kronish, I. M. (2014). Anxiety sensitivity and medication nonadherence in patients with uncontrolled hypertension. Journal of Psychosomatic Research, 77(4), 283–286. doi: 10.1016/j.jpsychores.2014.07.009.CrossRefPubMedPubMedCentralGoogle Scholar
- American Heart Association. (2016). Blood pressure testing and assessment. http://www.americanheart.org.
- Angst, J. (1988). Clinical course of affective disorders. In T. Helgason & R. Daly (Eds.), Depression illness: Prediction of course and outcome (pp. 1–47). Berlin: Springer.Google Scholar
- Bogner, H. R., Morales, K. H., de Vries, H. F., & Cappola, A. R. (2012). Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: A randomized controlled trial. Annals of Family Medicine, 10(1), 15–22. doi: 10.1370/afm.1344.CrossRefPubMedPubMedCentralGoogle Scholar
- Graham, H. (2007). Unequal lives: Health and socioeconomic inequalities. Maidenhead: Open University Press.Google Scholar
- Gums, T. H., Uribe, L., Vander Weg, M. W., James, P., Coffey, C., & Carter, B. L. (2015). Pharmacist intervention for blood pressure control: medication intensification and adherence. Journal of the American Society of Hypertension, 9(7), 569–578. doi: 10.1016/j.jash.2015.05.005.CrossRefPubMedPubMedCentralGoogle Scholar
- Khatib, R., Schwalm, J. D., Yusuf, S., Haynes, R. B., McKee, M., Khan, M., & Nieuwlaat, R. (2014). Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: A systematic review and meta-analysis of qualitative and quantitative studies. PLoS ONE, 9(1), e84238. doi: 10.1371/journal.pone.0084238.CrossRefPubMedPubMedCentralGoogle Scholar
- Kiel, J. M. (1999). Reshaping Maslow’s hierarchy of needs to reflect today’s educational and managerial philosophies. Journal of Instructional Pyschology, 26(3), 167–168.Google Scholar
- Novelli, W. D., Halvorson, G. C., & Santa, J. (2012). Recognizing an opinion: Findings from the IOM evidence communication innovation collaborative. Jama, 1–2. doi: 10.1001/jama.2012.13369.
- Piette, J. D., Striplin, D., Marinec, N., Chen, J., & Aikens, J. E. (2015). A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes. Medical Care, 53(8), 692–699. doi: 10.1097/MLR.0000000000000378.CrossRefPubMedPubMedCentralGoogle Scholar
- Thom, T., Haase, N., Rosamond, W., Howard, V. J., Rumsfeld, J., Manolio, T., & Wolf, P. (2006). Heart disease and stroke statistics–2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 113(6), e85–e151.CrossRefPubMedGoogle Scholar