Does Participatory Decision Making Improve Hypertension Self-Care Behaviors and Outcomes?

Authors

  • Alex H. Cho MD,

    1. From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham;1 and the Division of General Internal Medicine, Department of Medicine,2 the Center for Aging and Human Development,3 and the Department of Psychiatry and Behavioral Sciences,4 Duke University, Durham, NC
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  • 1,2 Corrine I. Voils PhD,

    1. From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham;1 and the Division of General Internal Medicine, Department of Medicine,2 the Center for Aging and Human Development,3 and the Department of Psychiatry and Behavioral Sciences,4 Duke University, Durham, NC
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  • 1 William S. Yancy Jr MD, MHS,

    1. From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham;1 and the Division of General Internal Medicine, Department of Medicine,2 the Center for Aging and Human Development,3 and the Department of Psychiatry and Behavioral Sciences,4 Duke University, Durham, NC
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  • 1,2 Eugene Z. Oddone MD, MHS,

    1. From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham;1 and the Division of General Internal Medicine, Department of Medicine,2 the Center for Aging and Human Development,3 and the Department of Psychiatry and Behavioral Sciences,4 Duke University, Durham, NC
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  • and 1,2,3 Hayden B. Bosworth PhD 1,2,3,4

    1. From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham;1 and the Division of General Internal Medicine, Department of Medicine,2 the Center for Aging and Human Development,3 and the Department of Psychiatry and Behavioral Sciences,4 Duke University, Durham, NC
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Alex H. Cho, MD, Center for Health Services Research in Primary Care, Veterans Affairs Medical Center Durham, 508 Fulton Street (152), Durham, NC 27705
E-mail: alex.cho@duke.edu

Abstract

This study examined patients' perceptions of their providers' participatory decision making (PDM) style and hypertension self-care behaviors and outcomes. Five hundred fifty-four veterans with hypertension enrolled in the Veterans' Study to Improve the Control of Hypertension rated providers' PDM styles using a validated 3-item instrument. Behaviors assessed included presence of a home blood pressure monitor, monitoring frequency, and self-reported antihypertensive medication adherence. Overall, veterans with hypertension rated providers as highly participatory. In adjusted analyses, a lower PDM score was associated with decreased odds of having a home monitor (odds ratio, 0.90 per 10-point decrement in PDM score; 95% confidence interval, 0.83–0.98) but not with monitoring frequency, adherence, or blood pressure control. Providers' involvement of patients in decision making, reflected in ratings of PDM style, may be important to securing patients' participation in their own care, but alone this factor seems insufficient. No relationship between PDM score and blood pressure control was observed.

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