Authors: (including presenting author): :
FU SN (1); DAO MC (1); LUK W (1); LAM CHM (2); HO SFI (1); CHEUNG SK (3); WONG CKH (4); CHEUNG BMY (5
Affiliation: :
(1)Department of Family Medicine & Primary Health Care, Kowloon West Cluster
(2)Hong Kong Academy of Nursing, HKCCPHN, Princess Margaret Hospital
(3)Department of Sociology, Hong Kong Shue Yan University
(4)Department of Family Medicine and Primary Care, The University of Hong Kong
(5)Department of Medicine, The University of Hong Kong
Introduction: :
Risk Assessment & Management Program (RAMP) has been proven to be an effective instrument for the control of blood pressure (BP) and cardiovascular (CVD) risk of hypertensive patients in general outpatient clinics (GOPCs).
Objectives: :
This study examines patients’ outcome upon the completion of a multidisciplinary structured group education and subsequent nurse follow-up (RAMP-group) by comparing with patients attending individual counselling alone (usual care, RAMP-individual). We also compared the outcome of patients with adequate and inadequate health literacy.
Methodology: :
A Prospective open cluster randomized controlled trial in 5 GOPCs under Princess Margaret Hospital, randomized to 3 RAMP-group and 2 RAMP-individual clinics.
Methods: Patients with uncontrolled hypertension (BP > 140/90mmHg) were recruited after they agreed to participate the research with informed consent. RAMP-group obtained a multidisciplinary group education that covered knowledge of hypertension, lifestyle modification and hands-on self-blood pressure monitoring (SBPM) training. SBPM devices were loaded to them for 6 weeks. Individual face-to-face nurse follow-up was arranged 6 weeks later. Patients’ office BP and clinical parameters were assessed at 6 months, 12 months and 18 months. Patients from RAMP-individual clinic had usual care. Subgroup analysis of patients’ BP control in those with adequate health literacy and inadequate health literacy were compared.
Result & Outcome: :
115 men and 176 women (mean age 67) were randomized to group (n=152) or individual care (n=139). Half patients (50%) had adequate health literacy while another half of patients had inadequate health literacy. After 18 months of treatment, there was a significantly higher BP control rate in RAMP-group than RAMP-individual (78.9% Vs 36.5%, p < 0.001). After subtracting mean BP of RAMP-group to RAMP-ndividual, there was a net reduction of systolic BP by 10.73mmHg (95% CI 7.77-13.68mmHg) and diastolic BP by 4.00mmHg (95% CI 1.56-6.45mmHg). There was 0.7kg (95% CI 0.0-1.4 kg) reduction of body weight. No adverse effect was reported.
Conclusions: The proposed RAMP-group demonstrated measurable improvement in BP control rate in poor controlled hypertensive patients in GOPC when compared with patients attended individual counselling alone.
