Abstract
BackgroundThis qualitative evaluation follows a randomized-control trial of a patient activation intervention in which hypertensive patients received a letter in the mail asking them to discuss thiazide diuretics with their provider. Results of the parent study indicated that the intervention was effective at facilitating discussions between patients and providers and enhancing thiazide prescribing rates. In the research presented here, our objective was to interview patients to determine their receptivity to patient activation, a potential leverage point for implementing interventions.MethodsSemi-structured phone interviews were conducted with 54 patients, purposefully sampled from a randomized controlled trial of a patient activation intervention. All subjects had a history of hypertension and received primary care from one of twelve Veterans Affairs primary care clinics. All interviews were transcribed verbatim and reviewed by the interviewer. Interviews were independently coded by three qualitative researchers until consensus was attained, and relevant themes and responses were identified, grouped, and compared. NVivo 8.0 was used for data management and analysis.ResultsData from this qualitative study revealed that most participants held favorable opinions toward the patient activation intervention used in the clinical trial. Most (82%) stated they had a positive reaction. Patients emphasized they liked the intervention because it was straightforward and encouraged them to initiate discussions with their provider. Also, by being active participants in their healthcare, patients felt more invested. Of the few patients offering negative feedback (11%), their main concern was discomfort with possibly challenging their providers' healthcare practices. Another outcome of interest was the patients' perceptions of why they were or were not prescribed a thiazide diuretic, for which several clinically relevant reasons were provided.ConclusionPatients' perceptions of the intervention indicated it was effective via the encouragement of dialogue between themselves and their provider regarding evidence-based treatment options for hypertension. Additionally, patients' experiences with thiazide prescribing discussions shed light on the facilitators and barriers to implementing clinical practice guidelines regarding thiazides as first-line therapy for hypertension.Trial registrationNational Clinical Trial Registry number NCT00265538
Highlights
This qualitative evaluation follows a randomized-control trial of a patient activation intervention in which hypertensive patients received a letter in the mail asking them to discuss thiazide diuretics with their provider
We describe patient perspectives of a patient activation intervention to encourage patients to talk with their primary care provider about initiating clinical practice guideline-concordant therapy for hypertension
The parent study involved a randomized controlled trial of a patient activation intervention to encourage hypertensive patients to speak with their provider about obtaining a prescription for a thiazide diuretic, first-line therapy for hypertension
Summary
This qualitative evaluation follows a randomized-control trial of a patient activation intervention in which hypertensive patients received a letter in the mail asking them to discuss thiazide diuretics with their provider. One method of establishing this bidirectional therapeutic decision-making process is by means of patientactivated interventions [2,3,4,14] Such interventions work to increase patient involvement in personal healthcare through patient education and skill-building, often targeted toward patients initiating specific conversations with their providers. Patient activation seeks to utilize elements of direct-to-consumer advertising by incorporating aspects of social marketing [17] to promote evidence-based therapies rather than brand-specific pharmaceuticals. These interventions could be a critical component of implementing guideline-concordant therapy in a consumer-driven healthcare approach [18,19], yet little is known about patients’ receptivity to such an intervention
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