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  • Title: [Shared decision-making with hypertensive patients. Results of an implementation in Germany].
    Author: Deinzer A, Babel H, Veelken R, Kohnen R, Schmieder RE.
    Journal: Dtsch Med Wochenschr; 2006 Nov 17; 131(46):2592-6. PubMed ID: 17096305.
    Abstract:
    BACKGROUND AND OBJECTIVE: Lack of compliance is a common problem in the treatment of hypertension. Ineffective physician-patient-communication and a lack of patients involvement can play a crucial role. We tested the hypothesis that shared decision-making (SDM) results in higher involvement of patients in their blood pressure lowering therapy and evaluated the effects of SDM on the control of blood pressure. PATIENTS AND METHODS: Two groups of 84 hypertensives were compared: an intervention group (26 women and 13 men, age 61 +/- 10 years) treated by 15 specially SDM-trained primary care physicians, and a control group of 45 hypertensives. All 84 patients were enrolled in a patient education programme. Changes of blood pressure were assessed after one year by self-measurements. Questionnaires about their attitude to patient autonomy, the SDM process, quality of life, physician-patient-relationship and life-style changes were analysed as well. RESULTS: After one year the blood pressure had decreased in both the intervention group (-9.26 +/- 10.2/-5.3 +/- 9.5 mmHg, p < 0.001) and in the control group (-6.0 +/- 11.8/-3.0 +/- 8.3 mmHg, p < 0.05), without a significant difference between the two groups. Among a subgroup of patients with a marked preference for SDM there was a close correlation between an increase of SDM and a decrease in systolic blood pressure (p = 0.016). Also, the numbers of antihypertensive drugs increased more in the intervention group (p = 0.022) than in control patients. Furthermore, increase in knowledge about hypertension and its treatment was greater in the intervention group (P=0.006). CONCLUSION: Implementation of SDM had a significant effect on systolic blood pressure control only in the subgroup of patients with marked preference for SDM. Thus, the identification of patients with a preference for SDM may improve blood pressure control and their adherence to the prescribed drug therapy.
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