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Highly
involved patients don't always see better
health outcomes
Newswise — Patients who
prefer to be highly involved in their
treatment don't necessarily have better luck
managing chronic health conditions, a new
study suggests.
A research team based
at the Veterans Affairs (VA) Iowa City
Health Care System and the University of
Iowa surveyed 189 veterans with high blood
pressure to determine the patients'
preferences for involvement in their health
care.
They discovered
those who wanted an active role in their
treatment had higher blood pressure and
cholesterol over a 12-month span than those
who wanted a less active role.
The study, published
this week in the Annals of Behavioral
Medicine, was led by Austin Baldwin, a
post-doctoral fellow in the Center for
Research in the Implementation of Innovative
Strategies in Practice (CRIISP) at the VA
Iowa City Health Care System and an adjunct
assistant professor of psychology in the UI
College of Liberal Arts and Sciences.
"The intuitive
assumption is that the more involved people
are with their health, the better they'll be
at managing chronic conditions. We found
evidence to the contrary," Baldwin said.
"Those who preferred a
more 'patient-centered' or active role
actually had higher blood pressure and lipid
levels. Those who preferred a
'provider-centered' approach, in which the
doctor is more authoritative, did better at
managing their blood pressure and lipid
levels."
Patients who preferred
the most active role averaged a blood
pressure of 141 over 79 and a low-density
lipoprotein (LDL) cholesterol level of 112,
while those who preferred the least active
role averaged a blood pressure of 137 over
72 and an LDL of 92.
Doctors tell most
patients with high blood pressure to aim for
a blood pressure less than 140 over 90 and
keep LDL cholesterol under 130.
The average participant
was 65.8 years old, and 97 percent were men.
Participants were recruited from the Iowa
City and Minneapolis VA health care systems
and four affiliated community-based
outpatient clinics as part of a larger
hypertension trial. The data were collected
in 2004.
The research team
offered a couple potential explanations for
the results.
One possibility is that
patients who wanted an active role were
dissatisfied with the relatively passive
treatment of taking medication to control
their conditions, and therefore may not have
followed doctors' orders as well.
"They were presumably
provided advice and guidance about modifying
their lifestyle, but all of these patients
were on hypertension medication, and many
were on lipid-lowering medications," Baldwin
said.
"For those who want
more control over their treatment, a
relatively passive treatment like taking
medication may not be a good match."
One aspect of the study
gave traction to this explanation. Some
patients were diabetic. While those who
preferred an active role did worse at
managing blood pressure and cholesterol,
they did slightly better at managing blood
sugar (although the effect on managing blood
sugar was not statistically significant).
Researchers believe that's because managing
blood sugar is a more hands-on treatment
involving blood sugar tests, diet regulation
and sometimes medication.
Another potential
explanation is that the patients' role
preferences didn't match their doctors' role
preferences.
While this study did
not assess providers' preferences, previous
research suggests that a mismatch between
patients' and providers' role preferences
impacts adherence to treatment
recommendations.
Baldwin said the
research is important because if health
professionals can assess patients' role
preferences, they could potentially tailor
treatment plans to give patients the best
chance for a successful outcome.
For example, patients
with high blood pressure who want an active
role could do better making more aggressive
lifestyle changes and tracking their
progress with a home blood pressure monitor,
he said.
"The upshot of this
research is that there isn't a
one-size-fits-all approach. It's nice to
think if we give everyone Treatment X,
they're all going to do well," Baldwin said.
"But individual
differences and preferences are important,
and the value of studying this is to
understand how these preferences can
influence treatment adherence and ultimately
influence people's health."
Co-authors of the paper
were Jamie Cvengros, a UI graduate student
in psychology and a clinical intern at Rush
Medical Center in Chicago; Alan Christensen,
professor and chair of the UI Department of
Psychology and an investigator at the VA
Iowa City Health Care System's CRIISP; Areef
Ishani, an investigator at the VA system in
Minneapolis; and Peter Kaboli, associate
professor of internal medicine in the UI Roy
J. and Lucille A. Carver College of Medicine
and an investigator at the VA Iowa City
Health Care System's CRIISP.
The VA Health Services
Research and Development Service provided
support for the study.
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