Leveraging Implementation and Behavioural Science to Improve Hypertension Management in Women by Primary Care Clinicians

Principal Investigator(s)

Dr. Ross T. Tsuyuki

Hypertension Canada (HC) President & Director, EPICORE, Department of Medicine, University of Alberta

 

Dr Jeremy Grimshaw

Centre for Implementation Research, Ottawa Hospital Research Institute (CIR-OHRI)

 

Dr. Kaitlyn E. Watson

Postdoctoral Research Fellow, EPICORE, Department of Medicine, University of Alberta

 

Co-Investigators

Sandra Robertshaw Patient Partner	Dr Paula Harvey Director, Cardiovascular Research Program, Women’s College Hospital
Louise Crane Patient Partner	Dr Noah Ivers Chair of Implementation Science at the Women’s College Research Institute (WCRI) & Primary Care Physician
Karen Moffat Patient Partner	Dr Justin Presseau Scientist, Centre for Implementation Research, Ottawa Hospital Research Institute (CIR-OHRI)
Dr Arden Barry Clinical Pharmacy and Research Specialist, Fraser Health & Assistant Professor (Partner), Faculty of Pharmaceutical Sciences, University of British Columbia	Dr Andrea Patey Scientist, Centre for Implementation Research, Ottawa Hospital Research Institute (CIR-OHRI)
Dr Colleen Norris Professor, Faculty of Nursing, University of Alberta	Dr Stella S. Daskalopoulou Co-Chair, HC Guidelines Committee & Associate Professor, Department of Medicine, McGill University
Dr Jia Hu Adjunct Professor, University of Calgary	Dr Doreen Rabi Co-Chair, HC Guidelines Committee & Professor and Division Director, Endocrinology and Metabolism, University of Calgary

 

Background:

In the last 2 decades, levels of hypertension awareness and control in Canada were the highest in the world, however, recent data from the Canadian Health Measures Survey indicate a disturbing downward trend, especially in women (now down to less than 50% controlled). Thus, greater implementation of evidence-based guidance for hypertension management into clinical practice is warranted. This study will take a systematic process to identify the variables and conditions that can lead to full and effective use of evidence-based guidelines into primary care, specifically for the management and prevention of hypertension in older women.

This study will focus on women over 40 years with uncontrolled hypertension and aims to identify elements of the evidence-based guidelines that are being underutilized in managing patients both from the healthcare professional and from the patient perspectives. We will then identify and address the gaps at the patient, provider, clinic, and/or policy level of the healthcare system.

Objectives:

This study will focus on women (>40 years) with uncontrolled hypertension and aims to identify elements of the evidence-based guidelines that are being underutilised in managing this patient population. We will then identify and address the gaps at the patient, provider, clinic, and/or policy level of the healthcare system. The objective of this study is to design theory-informed implementation strategies for key Hypertension Canada (HC) guideline recommendations from the patient and clinician perspective for women at risk of uncontrolled and under-managed hypertension.

Methods:

We will conduct an implementation study using the Theoretical Domain Framework (TDF) which is a comprehensive, theory-informed, and systematic approach to identify the actionable determinants of behaviour and behaviour change in clinicians and patients. We will use a systematic method for developing theory-informed implementation strategies that will involve 4 phases.

Phase 1 – we will identify the specific behaviours (who needs to do what, differently) of the evidence-based guidelines that are being underutilised for women at risk and to identify which level of the healthcare system (e.g., patient, provider, clinic, and/or policy level) the gap resides (i.e., to clarify who needs to do what differently).

Phase 2 (actively recruiting) – we will identify the barriers and enablers to implementation of guidelines for women (>40 years) into clinical practice. Qualitative semi-structured focus groups and interviews will be conducted with the identified ‘Actors’ from the Phase 1 study. There will be two arms to this phase, (1) Primary care clinicians and (2) patients, as the barriers and enablers to improving hypertension are vastly different from a healthcare provider point-of-view in comparison to that of patients.

Phase 3 – we will co-design implementation strategies and interventions for promoting uptake and integration of hypertension guidelines. We will hold co-facilitated workshops with key stakeholders and patients to discuss the key barriers identified in phase 2 that are modifiable, and the behaviour change techniques and delivery mechanisms that are suggested to be feasible for implementation for women over 40 years with hypertension.

Phase 4 – we will evaluate the theory-informed implementation strategies after this study and the previous 3 phases have been completed. We anticipate this to be evaluated in a randomized control trial (RCT) or cluster RCT which will measure the impact of the implementation strategies on systolic blood pressure control in women.

Contact

For more information or to discuss participating, please contact Dr. Kaitlyn Watson

kewatson@ualberta.ca | 780 903 3315