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(Circulation. 2008;117:1361-1368.)
© 2008 American Heart Association, Inc.

Health Services and Outcomes Research

Improving Hypertension Control in Diabetes Mellitus

The Effects of Collaborative and Proactive Health Communication

Aanand D. Naik, MD; Michael A. Kallen, PhD, MPH; Annette Walder, MS; Richard L. Street, Jr, PhD

From the Houston Center for Quality of Care and Utilization Studies (A.D.N., A.W., R.L.S.), Michael E. DeBakey VA Medical Center, Houston, Tex; Sections of Health Services Research (A.D.N., A.W., R.L.S.) and Geriatrics (A.D.N.), Baylor College of Medicine, Houston, Tex; Department of General Internal Medicine (M.A.K.), The University of Texas MD Anderson Cancer Center, Houston, Tex; and Department of Communication (R.L.S.), Texas A&M University, College Station, Tex.

Correspondence to Aanand D. Naik, MD, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030. E-mail anaik{at}bcm.tmc.edu

Received June 26, 2007; accepted December 26, 2007.

Background— Communication between patients and clinicians using collaborative goals and treatment plans may overcome barriers to achieving hypertension control in routine diabetes mellitus care. We assessed the interrelation of patient–clinician communication factors to determine their independent associations with hypertension control in diabetes care.

Methods and Results— We identified 566 older adults with diabetes mellitus and hypertension at the DeBakey VA Medical Center in Houston, Tex. Clinical and pharmacy data were collected, and a patient questionnaire was sent to all participants. A total of 212 individuals returned surveys. Logistic regression analyses were performed to assess the effect of patient characteristics, self-management behaviors, and communication factors on hypertension control. Three communication factors had significant associations with hypertension control. Two factors, patients’ endorsement of a shared decision-making style (odds ratio 1.61, 95% confidence interval 1.01 to 2.57) and proactive communication with one’s clinician about abnormal results of blood pressure self-monitoring (odds ratio 1.89, 95% confidence interval 1.10 to 3.26), had direct, independent associations in multivariate regression. Path analysis was used to investigate the direct and indirect effects of communication factors and hypertension control. Decision-making style (β=0.20, P<0.01) and proactive communication (β=0.50, P<0.0001) again demonstrated direct effects on hypertension control. A third factor, clinicians’ use of collaborative communication when setting treatment goals, had a total effect on hypertension control of 0.16 (P<0.05) through its direct effects on decision-making style (β=0.28, P<0.001) and proactive communication (β=0.22, P<0.01).

Conclusions— Three communication factors were found to have significant associations with hypertension control. Patient–clinician communication that facilitates collaborative blood pressure goals and patients’ input related to the progress of treatment may improve rates of hypertension control in diabetes care independent of medication adherence.

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