Taking the hard line approach to hypertension education: do emergency department patients prefer it?

Abstract

Study objectives: Emergency physicians have an opportunity to educate patients and improve health care, thereby reducing emergency department (ED) visits. It has been suggested that presenting worst-case scenarios causes patients to disconnect and does not improve treatment adherence. We aimed to determine what hypertension educational information ED patients report as most likely to improve treatment adherence. Methods: This written survey with 4-point Likert scale response was offered to all adults in an urban ED waiting room in 7 nonrandom 1-hour intervals. We provided 30 facts related to hypertension. Eight (26.7%) contained information about life-threatening complications of hypertension. We asked how likely each fact was to improve blood pressure monitoring and treatment adherence. Mean scores for responses to each fact were calculated and ranked for all respondents, hypertension patients, and those nonadherent with treatment. Two-tailed t test was used to compare mean scores for life threats versus non–life threat facts. Results: One hundred one surveys were completed; respondents were female, 51.9%; black, 62.5%; Hispanic, 20.2%; white, 6.7%; Asian, 3.8%; and other, 4.8%. The mean response rate for all facts was 79.1% (SD 1.5%). The highest-ranked facts for the overall group were life threats (means 3.56, 3.53; group mean 3.29, SD 0.16). The 50% with hypertension ranked life threats as the top 3 (means 3.62, 3.61, 3.59; group mean 3.34, SD 0.17). Only 67.3% of the hypertension group reported treatment adherence. The remainder (our target population) reported life threats as the top 3 (means 3.72, 3.69, 3.54; group mean 3.29, SD 0.19). All groups scored life-threat facts higher than non–life threats (overall P =.066; hypertension P =.03; target P =.009). Conclusion: We found that patients with hypertension, particularly those who are not adherent to treatment, rated life threats as most likely to improve treatment adherence. ED patients may share unique characteristics that alter their perception of life-threatening information. Taking the hard line on patient education may be the most effective approach in the ED.