Improving blood pressure control in diabetes: Limitations of a clinical reminder in influencing physician behavior

Abstract

Introduction: Hypertension should be aggressively treated, especially in diabetic patients. But studies of physician prescribing habits reveal that physicians often delay making medication changes or initiating antihypertensive therapy. A chart‐based reminder was designed to improve physician medication prescribing in this clinical situation. Methods: A randomized controlled trial was conducted at the Veterans Affairs Medical Center in Richmond, Virginia. Patients with diabetes and hypertension were selected. A highly visible chart reminder was applied to the front of outpatient charts in the intervention group practice. A chart review was conducted to assess physician‐directed medication changes. A successful outcome was defined as any antihypertensive medication increase or addition at that same visit. Results: Physicians were more likely to intensify antihypertensive medication as the blood pressure increased regardless of the reminder. Overall, only 33% of visits resulted in a medication change, even though 93% of patients had elevations over target blood pressure at the follow‐up visit. Physicians in the intervention and control groups made changes to medication at similar rates (χ² = 0.621, p = .511). Discussion: In this study, a chart reminder failed to improve physician compliance with the clinical guideline for hypertension management in diabetics, Sixth Report of the Joint National Committee on the Detection, Evaluation, Prevention and Treatment of High Blood Pressure. To inform the design of effective intervention strategies, further research should explore specific barriers to guideline adherence in this clinical situation.