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Improving Hypertension Control in Diabetes Mellitus. The Effects of Collaborative and Proactive Health Communication.

Circulation. 2008 Mar 3 Naik AD, Kallen MA, Walder A, Street RL Jr. Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Tex; Sections of Health Services Research and Geriatrics, Baylor College of Medicine, Houston, Tex; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex; and Department of Communication, Texas A&M University, College Station, Tex.

Background - Communication between patients and clinicians using collaborative goals and treatment plans may overcome barriers to achieving hypertension control in routine diabetes mellitus care. We assessed the interrelation of patient-clinician communication factors to determine their independent associations with hypertension control in diabetes care.

Methods and Results - We identified 566 older adults with diabetes mellitus and hypertension at the DeBakey VA Medical Center in Houston, Tex. Clinical and pharmacy data were collected, and a patient questionnaire was sent to all participants. A total of 212 individuals returned surveys. Logistic regression analyses were performed to assess the effect of patient characteristics, self-management behaviors, and communication factors on hypertension control. Three communication factors had significant associations with hypertension control. Two factors, patients' endorsement of a shared decision-making style (odds ratio 1.61, 95% confidence interval 1.01 to 2.57) and proactive communication with one's clinician about abnormal results of blood pressure self-monitoring (odds ratio 1.89, 95% confidence interval 1.10 to 3.26), had direct, independent associations in multivariate regression. Path analysis was used to investigate the direct and indirect effects of communication factors and hypertension control. Decision-making style (beta=0.20, P<0.01) and proactive communication (beta=0.50, P<0.0001) again demonstrated direct effects on hypertension control. A third factor, clinicians' use of collaborative communication when setting treatment goals, had a total effect on hypertension control of 0.16 (P<0.05) through its direct effects on decision-making style (beta=0.28, P<0.001) and proactive communication (beta=0.22, P<0.01).

Conclusions - Three communication factors were found to have significant associations with hypertension control. Patient-clinician communication that facilitates collaborative blood pressure goals and patients' input related to the progress of treatment may improve rates of hypertension control in diabetes care independent of medication adherence.

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