Supporting GPs and people with hypertension to maximise medication use to control blood pressure: A pilot cluster RCT of the MIAMI intervention

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

6D.1

Presenter:

Andrew W. Murphy

Co-authors:

Gerard J Molloy1, Eimear C Morrissey, Louise O Grady, Patrick J Murphy, Gerard J Molloy

Author institutions:

Discipline of Psychology and HRB Primary Care Clinical Trials Network Ireland, University of Galway

Problem

Hypertension is one of the most important risk factors for stroke and heart disease. A landmark study of twelve high income countries from 1976-2017 concluded that hypertension ‘control rates have plateaued in the past decade, at levels lower than those in high quality hypertension programmes’. International comparisons suggests that in Ireland there are relatively low levels of awareness of hypertension and relatively poor levels of control and suboptimal treatment. The ‘MaxImising Adherence, Minimising Inertia’ (MIAMI) intervention, which has been developed using a systematic, theoretical, user-centred approach, aims to support GPs and people with hypertension to maximise medication use.

Approach

The MIAMI intervention is designed to support General Practitioners (GPs) and people living with hypertension to maximise medication use to control blood pressure. It contains GP targeted components (30 minute online training, booklet and consultation guide) and patient targeted components (Urine chemical adherence test, pre-consultation plan and informational videos). The aim of this study was to gather and analyse acceptability and feasibility data to allow (1) further refinement of the MIAMI intervention, and (2) determination of the feasibility of evaluating the MIAMI intervention in a future definitive RCT.

Findings

Six general practices (Target 6) and 52 people (Target 60) living with hypertension were recruited. All 6 practices were retained. Four patient participants were lost to follow up (8%). Fidelity, as measured on a study delivery checklist, was good but there were three processes that were not delivered as intended. Two of these were minor processes, but the third was the delivery of the urine test results, which often did not occur due to delays in the delivery of results and some confusion around accuracy. The qualitative data demonstrated that the urine test component is not feasible in its current form but the other intervention components had good feasibility and acceptability.

Consequences

Some modifications are required to the MIAMI intervention components and research processes but with these in place progression to a definitive RCT is considered feasible. Trial registration:ISRCTN85009436

Submitted by:

Andrew W. Murphy

Funding acknowledgement:

The Health Research Board [HRB-DIFA-2020-012].