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Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients
Hypertension Research ( IF 4.3 ) Pub Date : 2020-04-01 , DOI: 10.1038/s41440-020-0431-3 James Rufus John 1, 2 , W Kathy Tannous 3 , Amanda Jones 4
Hypertension Research ( IF 4.3 ) Pub Date : 2020-04-01 , DOI: 10.1038/s41440-020-0431-3 James Rufus John 1, 2 , W Kathy Tannous 3 , Amanda Jones 4
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Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (−3.4 mmHg; 95% CI −5.1, −1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively.
中文翻译：
以患者为中心的初级保健与标准保健模式对高血压患者血压结果的有效性
患有高血压和其他合并症的患者具有复杂的医疗保健需求，在初级保健中难以管理。然而，有强有力的证据表明，初级保健中以患者为中心的方法在管理复杂的多发病方面是有效的。我们旨在评估以患者为中心的医疗家庭模型（称为“WellNet”）与标准护理对高血压患者血压 (BP) 结果的有效性。我们使用队列研究设计与对照组和案例系列设计来评估 WellNet 计划在澳大利亚悉尼的六个一般实践中提供的“组间”和“组内”有效性。治疗组包括 447 名符合条件的患者，他们同意并接受全科医生主导的护理，并整合了护理协调员。对照组包括 5237 名匹配的患者，他们在四个地理上可比的全科诊所接受常规护理。为了评估随时间的变化，使用配对和独立样本 t 检验来确定显着差异。此外，协方差分析 (ANCOVA) 用于在调整潜在协变量后识别任何显着差异。调整后的模型显示治疗组的收缩压显着降低（-3.4 mmHg；95% CI -5.1，-1.7；p 值 < 0.001）。然而，在舒张压中没有观察到显着的平均变化。发现治疗组在推荐范围内的患者比例显着高于对照组（13.6% vs 6.4%）。WellNet 患者在随访期间经历了具有统计学意义和临床意义的血压改善。这项研究的结果可能分别在改善健康结果和提供护理方面对患者和提供者都有好处。
更新日期：2020-04-01
中文翻译：
以患者为中心的初级保健与标准保健模式对高血压患者血压结果的有效性
患有高血压和其他合并症的患者具有复杂的医疗保健需求，在初级保健中难以管理。然而，有强有力的证据表明，初级保健中以患者为中心的方法在管理复杂的多发病方面是有效的。我们旨在评估以患者为中心的医疗家庭模型（称为“WellNet”）与标准护理对高血压患者血压 (BP) 结果的有效性。我们使用队列研究设计与对照组和案例系列设计来评估 WellNet 计划在澳大利亚悉尼的六个一般实践中提供的“组间”和“组内”有效性。治疗组包括 447 名符合条件的患者，他们同意并接受全科医生主导的护理，并整合了护理协调员。对照组包括 5237 名匹配的患者，他们在四个地理上可比的全科诊所接受常规护理。为了评估随时间的变化，使用配对和独立样本 t 检验来确定显着差异。此外，协方差分析 (ANCOVA) 用于在调整潜在协变量后识别任何显着差异。调整后的模型显示治疗组的收缩压显着降低（-3.4 mmHg；95% CI -5.1，-1.7；p 值 < 0.001）。然而，在舒张压中没有观察到显着的平均变化。发现治疗组在推荐范围内的患者比例显着高于对照组（13.6% vs 6.4%）。WellNet 患者在随访期间经历了具有统计学意义和临床意义的血压改善。这项研究的结果可能分别在改善健康结果和提供护理方面对患者和提供者都有好处。
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