Physician & Patient Education Study

FOR IMMEDIATE RELEASE: March 30, 2005
Contact: Bill Seiler bseiler@umm.edu 410-328-8919
University of Maryland School of Medicine
Phyllis T. Reese phyllis_reese@bshsi.com 410-362-3575
Bon Secours Baltimore Health System

UNIVERSITY OF MARYLAND AND BON SECOURS LAUNCH MAJOR STUDY TO IMPROVE HEALTH THROUGH PHYSICIAN & PATIENT EDUCATION

Goal is to reduce treatment disparities for people with diabetes and hypertension

Elijah Saunders, M.D.

The University of Maryland School of Medicine and the Bon Secours Baltimore Health System are investigating the effectiveness of education to improve the health of patients diagnosed with either hypertension or diabetes. The study, called the Baltimore Cardiovascular Partnership, will evaluate whether physician training in the latest treatment guidelines, combined with intensive instruction for patients makes a difference. The institutions have each received $3 million grants from the National Heart, Lung and Blood Institute for the five-year study.

The study will focus on African-Americans, who are at high risk for hypertension and diabetes. The goal is to help them gain better control of their disease by promoting early diagnosis and comprehensive treatment.

“Overall in the United States, we are not doing well in the treatment of hypertension and diabetes, especially among African-Americans, where differences in the quality of treatment between whites and blacks are striking,” says one of the principal investigators, Elijah Saunders, M.D., professor of medicine at the University of Maryland School of Medicine and a cardiologist at the University of Maryland Medical Center.

Dr. Saunders says only 40 percent of blacks being treated for hypertension are able to meet goals in reducing their blood pressure levels, compared to 54 percent of whites. “Hypertension is often more advanced by the time it is diagnosed in African-Americans, which increases the risk of heart, kidney and brain damage,” says Dr. Saunders, who helped develop the national guidelines for the treatment of hypertension.

Diabetes is another major health problem among African-Americans. According to the American Diabetes Association, 2.7 million or 11.4 percent of African-Americans age 20 and older have diabetes.

“For diabetic patients in the study, our goal is to lower blood sugar levels to the point that we can reduce their risk of heart disease and stroke, which are major health issues associated with diabetes,” says Reed Winston, M.D., Ph.D., medical director, Ambulatory Services, Bon Secours Baltimore Health System and principal investigator for the diabetes arm of the study. “Controlled blood sugar levels will also reduce the complications of diabetes, such as blindness, kidney failure, nerve damage and foot problems that may lead to amputation,” he says.

Researchers from the University of Maryland School of Pharmacy will collaborate by collecting and analyzing data from the study, which will include 1,600 patients with uncontrolled hypertension or diabetes and 20 physicians.

“We will attempt to bolster knowledge about the treatment of both diseases, increase patient adherence to medication guidelines, boost health outcomes and assess the correlation among these three factors,” says a co-principal investigator, Fadia T. Shaya, Ph.D., M.P.H., an assistant professor at the University of Maryland School of Pharmacy and associate director of the Center on Drugs and Public Policy.

The randomized clinical trial will follow the progress of two groups, each with 800 patients. University of Maryland physicians who specialize in general internal medicine and family medicine will provide care for the group of participants with hypertension. Physicians affiliated with Bon Secours will provide care for the other group, diagnosed with diabetes. Recruitment for volunteers will begin April 1, 2005, and continue for two-and-a-half years.

For the study, half of the physicians and half of the patients in both groups will receive specialized education. The doctors will learn the most recent national guidelines for the treatment of hypertension and diabetes and tips on how to help patients manage their disease. A combined team of experts from Bon Secours and the University of Maryland Schools of Medicine and Pharmacy will teach the 90-minute classes to physicians on a regularly scheduled basis.

Half of the patients in the study will receive 30 minutes of special instruction and counseling from a nurse as part of each clinical visit. The counseling will encompass everything from how to make healthy diet and lifestyle choices to the importance of taking medication as prescribed. The other patients will not receive this counseling, but will continue to receive regular care from their health care providers.

To evaluate the impact of the education and counseling program, the patients will be tested later on their knowledge of hypertension or diabetes and their adherence to guidelines. The researchers will also look at the patients’ health outcomes, such as blood pressure or blood sugar levels.

For patients with hypertension, the goal is to reduce blood pressure below 140/90 mm Hg (millimeters of mercury) during the course of the study. For patients with diabetes, the goal is to achieve a glycated hemoglobin or HbA1c test level (a measure of long-term blood sugar control) that is below seven.

“I think the study will foster better communication among physicians in the community and those at the University of Maryland,” says Dr. Winston.

“Community doctors will receive the benefit of instruction in the latest treatment guidelines, and we hope that university doctors will gain a better appreciation of the everyday barriers to treatment that community physicians and their patients face, including the cost of medicines and reluctance to use the health care system,” adds Dr. Winston.

He says high-fat and high-sugar foods, which are heavily advertised in the community, along with the abundance in some neighborhoods of fast food restaurants that offer narrow food options, add to the challenge.

The study leaders have enlisted the help of a variety of organizations, including community centers, faith-based groups and a business group, to support the study at a grassroots level. “We want to make sure that our interventions are consistent with how people in the community work, play and pray,” says Dr. Shaya. “Ideally, we want to empower patients to take an active role in what happens to them once they have been diagnosed with hypertension or diabetes.”

An additional aim of the study, according to Dr. Shaya, is to build a platform in Baltimore that could be a national model for helping people control hypertension and diabetes, two large and growing health problems in the U.S.

According to co-principal investigator Wallace R. Johnson, Jr., M.D., “doctors and their patients both do better in their efforts to control hypertension and diabetes when the guidelines are communicated in ways that motivate patients and overcome barriers. This study has the potential to demonstrate that.” Dr. Johnson is a clinical assistant professor at the University of Maryland School of Medicine

Those interested in information about the study and how to participate are invited to call 410-706-6226.

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