Felix-Aaron K, Hill MN, Rubin HR; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Kaytura Felix-Aaron, M.D., Community Health Scholar, Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, Rm. 611, Baltimore, MD 21205. Tel: 443/463-6831; Fax; 410/653-0794; e-mail: kfaaron@jhshp.edu
Research Objective: An intensive nurse practitioner-community health worker (NP-CHW) intervention improved blood pressure modestly among young urban black hypertensive men. We investigated the impact of this intervention on patient satisfaction with medical care for high blood pressure (HBP).Study Design: 309 men were randomly assigned to receive a less intensive (LI) intervention (one-time HBP education and referral) or a more intensive (MI) intervention, including HBP education and HBP management by a NP-CHW team. At their 24-month follow-up, participants received a satisfaction questionnaire comprising of ratings of overall satisfaction (1,not at all, to 5,extremely satisfied) and 37 ratings of quality of 10 aspects of care (1,poor, to 5,excellent ). Population Studied: African-American men. Principal Findings: 82% (N=255) completed the questionnaire. MI and LI groups were similar at baseline in age (mean MI 42, LI 41 years), education (mean MI 11, LI 12 years), and the proportions using illicit drugs (51% MI, 48% LI), reporting excellent health status (8% MI, 4% LI), and without health insurance (58% MI, 48% LI). Both groups rated items relating to provider technical quality (35-37% excellent), information (33-37% excellent) and interpersonal treatment (35-37% excellent) better than access issues (20-26% excellent). More than twice as many MI patients were extremely satisfied with the way their MD or NP took care of them (55% vs. 27%), and with "medical care for HBP" (55% vs. 26%). Domains with the largest differences between groups in excellent ratings were information (24-28% difference, e.g., 49 vs. 21% excellent rating of helpfulness of advice on HBP and how to keep healthy, difference 28%, 95%CI (17%,39%)); technical quality (27-28% difference, e.g.,46% vs.19% excellent rating of the MD or NP's ability to figure out what's wrong with you, difference 27%, 95%CI (17, 37)); and interpersonal treatment (25-27% difference, e.g., helpfulness, friendliness, and caring of the MD or NP, 46% vs. 20% excellent rating, difference 26%, 95%CI (16,36)). There were less marked but still substantial differences between the MI and LI patients in ratings of access issues (e.g., ease of getting medications, 30% vs. 14% excellent rating, difference 16%, 95%CI(6, 26). Groups were similar in a few items.Conclusion: An intensive NP-CHW intervention that modestly lowered blood pressure also dramatically improved several dimensions of patient satisfaction with medical care for HBP in young black urban men, a group with low ratings of care at baseline and at high risk for treatment dropout. Implications for Policy, Delivery or Practice: It is possible to improve young African-American men's experiences of care. Future research should explore whether these better rating predict adherence to medical treatment and lower risk of preventable cardiovascular disease.Primary Source of Funding: NIH.
Publication Types:
Keywords:
- African Americans
- African Continental Ancestry Group
- Blood Pressure
- Clinical Trials as Topic
- Community Health Aides
- Counseling
- Health Status
- Humans
- Hypertension
- Male
- Nurse Practitioners
- Occupations
- Patient Satisfaction
- Poverty
- Questionnaires
- Research Design
- Sample Size
- methods
- hsrmtgs
Other ID:
UI: 102272635
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