April 2003 - August 2006

Group Visits to Improve Hypertension Management


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Brian B. Hoffman, MD
Co-principle Investigator
Mary Goldstein Profile
Principal Investigator
  • Professor, Health Policy
  • Professor, Medicine (by courtesy)
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Catharine Fenn, PhD

Research objectives:

The primary goal of this project is to improve blood pressure control in patients with hypertension through a new model of care delivery, Group Medical Visits. Patients with hypertension receive regular medical care in a group setting that is designed to promote effective self-management of hypertension and to encourage patients to follow their primary care clinician's advice. Clinicians are given guideline-based information on antihypertensive drugs through the ATHENA Decision Support System.

A secondary goal of the project is to evaluate and document the barriers and facilitators encountered in the implementation of this clinical model to the General Medical Clinic at the VA Palo Alto Health Care System. If this program of group visits enhances quality of care, the information gathered on organizational barriers and facilitators will be used to create a methodology for introducing group medical appointments in other VA settings.

Research plan and methods

Primary care clinicians (physicians and nurse practitioners) were randomly assigned to participate in group medical visits or a control comparison group. Patients were randomly assigned to participate in group visits or treatment as usual (control group). Approximately 250 patients and 16 primary care clinicians enrolled over an 18-month period. The program was evaluated at 6 and 12 months after the first group medical appointment. These evaluations have been used to redesign the intervention. A final evaluation will be conducted at 18 months. The data will be used to analyze changes in patient's blood pressures and medication adherence by comparing the control group patients with the patients attending group medical appointments. In addition, the research team is conducting interviews with key stakeholders, including primary care clinicians, nursing staff, clerical staff, and administrators. Clinician, patient, and health care factors will be evaluated to determine the elements involved in successfully making organizational changes to implement the group visits model in a primary care setting at the VA.