Is a shared decision-making approach effective in improving hypertension management?

The authors assessed whether patient empowerment in the management of hypertension improved more with the practice of shared decision making (SDM) than by education programs. In a prospective controlled clinical study, 15 general practitioners in Nuremberg, Germany who were specially trained to conduct SDM consultations participated in a 12-month study. Hypertensive patients (N=86) were included; N=40 were in the SDM group and N=46 were in the control group, if blood pressures were > or = 135 / 85 mm Hg (self measurement) and patients had no signs of cardiovascular complications or severe hypertension. All participants in the SDM group and the control group were enrolled in an education program on hypertension in small groups. The SDM group participants also had 4 special consultations to share medical decisions. The main outcome measures were the effect of SDM on blood pressure control. After 1 year blood pressure had decreased in all participants: Delta-9.26 +/- 10.2 mm Hg/Delta-5.33 +/- 9.5 mm Hg in the SDM group (P<0.001) compared to Delta-6.0 +/- 11.8 mm Hg/Delta-3.0 +/- 8.3 mm Hg in the control group. There was no significant difference between the 2 groups. The study group practiced more SDM than controls, but blood pressure control was not significantly better. Patient empowerment by means of an education program in small groups and creating awareness of hypertensive disease helps to improve the outcome of hypertension treatment. SDM, however, did not improve management when compared to an education program, which is much easier to implement in general practice.

Participation preferences of patients with acute and chronic conditions.

BACKGROUND: There is little knowledge as to whether the chronicity of a disease affects patients' desire for participation. AIM: To study whether participation preferences vary according to the type of disease. DESIGN, PARTICIPANTS AND METHODS: Data of 1,393 patients from six trials with different medical conditions (hypertension, depression, breast cancer, schizophrenia, multiple sclerosis, minor traumas) were pooled and analysed, using multiple regression analysis controlling for socio-demographic variables. RESULTS: Younger age, better education as well as female gender accounted for a small but statistically significantly greater desire to participate. Patients suffering from multiple sclerosis (MS) exhibited significantly higher participation preferences than the other diagnostic groups. There were no major differences between the other diagnostic groups. Age, gender, education and diagnosis explained only 14% of the variance. CONCLUSIONS: We found no clear differences between chronic and acute conditions. However, patients suffering from MS, a chronic condition, were clearly different from all other diagnostic groups. The reasons for this difference remain unclear. The predictive value of socio-demography and type of illness is low.