Part I, Patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA Project to Implement Diuretics (VAPID)

Stacey A Pilling; Monica B Williams; Rachel Horner Brackett; Ryan Gourley; Mark W Vander Weg; Alan J Christensen; Peter J Kaboli; Heather Schacht Reisinger

doi:10.1186/1748-5908-5-23

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Part I, Patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA Project to Implement Diuretics (VAPID)

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Part I, Patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA Project to Implement Diuretics (VAPID)

Stacey A Pilling, Monica B Williams, Rachel Horner Brackett, Ryan Gourley, Mark W Vander Weg, Alan J Christensen, Peter J Kaboli and Heather Schacht Reisinger

Implementation science : IS, Vol.5(1), pp.23-23

03/18/2010

DOI: 10.1186/1748-5908-5-23

PMCID: PMC2850871

PMID: 20298563

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Abstract

Background: This qualitative evaluation follows a randomized-control trial of a patient activation intervention in which hypertensive patients received a letter in the mail asking them to discuss thiazide diuretics with their provider. Results of the parent study indicated that the intervention was effective at facilitating discussions between patients and providers and enhancing thiazide prescribing rates. In the research presented here, our objective was to interview patients to determine their receptivity to patient activation, a potential leverage point for implementing interventions. Methods: Semi-structured phone interviews were conducted with 54 patients, purposefully sampled from a randomized controlled trial of a patient activation intervention. All subjects had a history of hypertension and received primary care from one of twelve Veterans Affairs primary care clinics. All interviews were transcribed verbatim and reviewed by the interviewer. Interviews were independently coded by three qualitative researchers until consensus was attained, and relevant themes and responses were identified, grouped, and compared. NVivo 8.0 was used for data management and analysis. Results: Data from this qualitative study revealed that most participants held favorable opinions toward the patient activation intervention used in the clinical trial. Most (82%) stated they had a positive reaction. Patients emphasized they liked the intervention because it was straightforward and encouraged them to initiate discussions with their provider. Also, by being active participants in their healthcare, patients felt more invested. Of the few patients offering negative feedback (11%), their main concern was discomfort with possibly challenging their providers' healthcare practices. Another outcome of interest was the patients' perceptions of why they were or were not prescribed a thiazide diuretic, for which several clinically relevant reasons were provided. Conclusion: Patients' perceptions of the intervention indicated it was effective via the encouragement of dialogue between themselves and their provider regarding evidence-based treatment options for hypertension. Additionally, patients' experiences with thiazide prescribing discussions shed light on the facilitators and barriers to implementing clinical practice guidelines regarding thiazides as first-line therapy for hypertension.

Details

Title: Subtitle: Part I, Patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA Project to Implement Diuretics (VAPID)
Creators: Stacey A Pilling - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Monica B Williams - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Rachel Horner Brackett - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Ryan Gourley - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Mark W Vander Weg - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Alan J Christensen - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Peter J Kaboli - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Heather Schacht Reisinger - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 601 Hwy 6 West, Mail Stop 152, Iowa City, IA, 52246-2208, USA
Resource Type: Journal article
Publication Details: Implementation science : IS, Vol.5(1), pp.23-23
DOI: 10.1186/1748-5908-5-23
PMID: 20298563
PMCID: PMC2850871
NLM abbreviation: Implement Sci
ISSN: 1748-5908
eISSN: 1748-5908
Publisher: BioMed Central
Language: English
Date published: 03/18/2010
Academic Unit: Epidemiology; Psychological and Brain Sciences; Center for Social Science Innovation; Injury Prevention Research Center; Community and Behavioral Health; Internal Medicine
Record Identifier: 9984063134002771

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