Peer Comparison Feedback for High Blood Pressure

Overseen By Shivan Mehta, MD,MBA,MSHP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Must be taking: Anti-hypertensives

Disqualifiers: Frailty, Advanced illness, Renal disease, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

93 Participants Needed

Trial Summary

What is the purpose of this trial?

As part of a roll out of new payment model for physicians based on hypertension control, the investigators will evaluate a monthly peer comparison message to Primary Care Providers at Penn Medicine Lancaster to see whether provider engagement with patients' overall hypertension management increases, as measured by new or increasing doses of anti-hypertensive medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems to focus on evaluating doctors' management of high blood pressure, so it's best to ask the trial coordinators for more details.

What data supports the effectiveness of the treatment Peer Comparison Message for high blood pressure?

Research shows that providing peer comparison feedback to physicians can improve the management of high blood pressure, as seen in a study where uncontrolled hypertension decreased from 46.8% to 34.3% after implementing peer review and feedback. This suggests that peer comparison messages can be effective in improving blood pressure control. ^{1 2 3 4 5}

Is Peer Comparison Feedback for High Blood Pressure safe for humans?

There is no specific safety data available for Peer Comparison Feedback for High Blood Pressure, but peer support programs for managing hypertension generally focus on motivation and self-management, which are considered safe approaches. ^{6 7 8 9 10}

How does the treatment 'Peer Comparison Feedback' for high blood pressure differ from other treatments?

Peer Comparison Feedback is unique because it focuses on modifying physician behavior through performance report cards, rather than directly treating the patient with medication or lifestyle changes. This approach aims to improve clinical performance and patient outcomes by providing physicians with feedback on their performance compared to their peers. ^{1 3 11 12 13}

Research Team

Shivan Mehta, MD,MBA,MSHP

Principal Investigator

University of Pennsylvania

Eligibility Criteria

This trial is for Primary Care Providers at Penn Medicine Lancaster with at least 30 patients who have high blood pressure. These patients must be aged 18-85 and have had a diagnosis of hypertension in the last two years. Excluded are providers with fewer than 30 such patients, those caring for patients with end stage renal disease, recent pregnancy, or indicators of end-of-life care.

Inclusion Criteria

My blood pressure was over 140/90 at my last doctor's visit within the year.

Primary Care Providers who have at least 30 patients with hypertension as determined by the HTN quality metric

Exclusion Criteria

I have not been in comfort or palliative care in the last year.

I am not over 65 with frailty or have had an advanced illness diagnosis in the past year.

Primary Care Providers includes providers with less than 30 patients in the HTN quality metric

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Primary Care Providers receive monthly peer comparison messages to improve hypertension management

6 months

Monthly feedback sessions

Control

Primary Care Providers continue with usual care and access hypertension control rates via EPIC dashboard

6 months

Follow-up

Participants are monitored for changes in hypertensive medication prescriptions and hypertension control percentage

6 months

Treatment Details

Interventions

• Peer Comparison Message

Trial Overview The study tests if sending monthly peer comparison messages to doctors can improve how they manage high blood pressure. It looks at whether these messages encourage doctors to start or increase doses of blood pressure medications among their patients.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

This group will receive peer comparison messages.

Group II: Control Active Control 1 Intervention

This group will not receive peer comparison messages and will continue with usual care.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Findings from Research

A peer support program involving Veterans of Foreign Wars posts in Wisconsin effectively trained 27 peer leaders over 18 months to promote self-management of hypertension, with 93% of participating posts remaining active throughout the study.

The program resulted in peer leaders gaining health knowledge and confidence, which enhanced health support among veterans, highlighting the potential of community-based initiatives in improving chronic disease management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary description of the feasibility of using peer leaders to encourage hypertension self-management. Hayes, A., Morzinski, J., Ertl, K., et al.[2010]

A study from the Boston Collaborative Drug Surveillance Program found that while 'nuisance' adverse drug reactions (ADRs) from antihypertensive medications occur in 10 to 29% of patients, 'life-threatening' ADRs are very rare, occurring in less than 1%.

Clinicians should consider the potential severity and type of ADRs, along with patient compliance and education, when selecting antihypertensive therapies to ensure effective treatment and minimize negative impacts on patient adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug reactions during treatment of hypertension. Kellaway, GS.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

Can peer-comparison feedback improve patient functional status? [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Assessing The Effectiveness Of Peer Comparisons As A Way To Improve Health Care Quality. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Using Peer Feedback to Promote Clinical Excellence in Hospital Medicine. [2021]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of Audit and Feedback on Physician Adherence to Clinical Practice Guidelines for Pneumonia and Sepsis. [2020]

5. England pubmed.ncbi.nlm.nih.gov

A peer review programme to audit the management of hypertensive patients in family practices in Israel. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Preliminary description of the feasibility of using peer leaders to encourage hypertension self-management. [2010]

7. New Zealand pubmed.ncbi.nlm.nih.gov

Adverse drug reactions during treatment of hypertension. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Patient self-monitoring of blood pressure and self-titration of medication in primary care: the TASMINH2 trial qualitative study of health professionals' experiences. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Assessment of drug-induced increases in blood pressure during drug development: report from the Cardiac Safety Research Consortium. [2013]

11. United States pubmed.ncbi.nlm.nih.gov

Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Peer review checklist: reproducibility and validity of a method for evaluating the quality of ambulatory care. [2019]

13. England pubmed.ncbi.nlm.nih.gov

Quality assurance in radiology: peer review and peer feedback. [2015]