Collaboration to Reduce Disparities in Hypertension

The objective of this study is to determine the effectiveness and cost-effectiveness of two interventions aimed at reducing barriers to blood pressure (BP) control in an indigent and African-American population. Specifically, we will conduct a randomized controlled trial comparing BP control using either: (1) reimbursing patients for filling prescriptions (reimbursement arm); (2) a computer-based behavioral intervention (behavioral arm); (3) both the reimbursement and behavioral arms (combined arms); or (4) neither.

The ultimate goal of this study is to reduce the incidence of HTN-related CVD among these populations thereby reducing cardiovascular health disparities. Specific aims of the study are to:

• test whether receiving money each time the patient fills a prescription for medications improves BP control by a clinically significant amount.

H1: Reimbursing patients for filling prescriptions will significantly improve BP control.

• test whether a computer-based behavioral intervention improves BP control by a clinically significant amount.

H2: A computer-based behavioral intervention will significantly improve BP control.

• test whether the two interventions are more effective in improving BP control than either alone.

H3: The effect of improving BP control of administering both interventions together will be greater than the sum of the individual effects of each intervention alone.

• examine the relative cost effectiveness of reimbursement for filling prescriptions, a computer-based behavioral intervention, and the combination of the two.

H4: Both interventions will be cost-effective relative to other commonly-covered services.

Inclusion criteria

• Patients of the Philadelphia Veterans Administration Hospital Primary Care Clinic, PinnacleHealth Adult Outpatient Clinics and the VA Pittsburgh Healthcare System who have a diagnosis of hypertension; are currently taking antihypertensive medications; and have elevated blood pressure.

Exclusion criteria

• Under 21 years of age
• Have a diagnosis of:

• Atrial fibrillation;
• Metastatic cancer;
• End stage renal disease (ESRD) with dialysis;
• Dementia;
• New York Heart Association (NYHA) class IV congestive heart failure (CHF);
• Blind or deaf;
• Other reason for life expectancy of less than 1 year.
• Are currently participating in another experimental study