COUNSELING AFRICAN AMERICANS TO CONTROL HYPERTENSION STUDY (CAATCH)

Project Background and Goals:

This five-year project, funded by the National Heart, Lung and Blood Institute (NHLBI), will test the effect on BP control, of a multi-component, multi-level intervention targeted at clinicians and patients. We will conduct a clustered randomized controlled trial in which 30 Community/Migrant Health Centers (C/MHCs) will be randomized to either the Intervention or Usual Care. A total of 990 patients with uncontrolled hypertension (HTN) (BP> 140/90 mm Hg) will be enrolled and followed for this trial.

Components of the patient intervention include an innovative patient education approach known as Self-Paced Programmed Instruction (SPPI) that will be used to educate patients on knowledge of HTN; behavioral counseling by trained C/MHC dieticians and health educators on lifestyle modification; and home blood pressure (BP) monitoring to activate patients in their own self-management. The clinician intervention includes on-line CME courses on management of HTN based on JNC-7 guidelines; online HTN rounds/case conferences with HTN specialists; and feedback to physicians on clinical performance measures via computerized decision support systems. The intervention will be delivered to patients every 3 months during regular office visits for 12 months, while the physician intervention will occur every month for the duration of the trial. Patients and clinicians in the Usual Care C/MHCs will receive NHLBI patient education materials and print versions of JNC-7 guidelines.

The primary outcome is the proportion of patients with adequate BP control at 12 months in each condition as defined by JNC-7 criteria (BP<130/80 mm Hg or patients with diabetes or kidney disease; and BP <140/90 mm Hg for all other patients). The secondary outcomes are within-patient change in systolic blood pressure (SBP) and diastolic (DBP) from baseline to 12 months; the maintenance of the intervention effects one year after trial; and the cost effectiveness of the intervention at 12 months.

The long-term goal of this project is to refine the intervention as a result of the data obtained and to develop a standardized protocol that can be integrated into the usual care procedures of the C/MHCs, thereby maximizing the likelihood that the intervention will be translated into practice at each of the participating Community Health Centers.

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