Ten more years of life: Development and evaluation of a therapeutic education project for hypertensive patients. Preliminary results

Introduction: The Ten More Years of Life Project is a therapeutic education project developed by the HypertensionWorking Group of the Cardarelli Hospital in Naples, Italy. It was designed reduce blood pressure (BP) in hypertensive patients by improving their compliance with physicians' recommendations. Thanks to regional funding, the project was transferred from the hospital to the general practice setting. This article reports the preliminary results.
Materials and methods: Eleven general practitioners (GP) participated in the project, and 821 hypertensive patients were enrolled. Patients were randomly assigned to the control group (Group C, n = 420) or the intervention group (Group I, n = 401). At baseline (t = 0) and 12 months later (t = 12), patients in both groups 1) filled out a 10-item multiple-choice questionnaire developed to evaluate the effect of the intervention on lifestyle modification, 2) responded to the Short Form Health Survey (SF-36) questionnaire, 3) had BP measured, laboratory data collected, and registration of current drug therapy. The Intervention Group patients took part in 3 interactive educational sessions held 2, 4, and 9 months after enrolment. The information was transmitted to patients by means of a printed leaflet, moderated group discussions, and role-playing sessions. The Control Group returned to the center 2, 4, and 9 months after enrolment and received the same information in verbal form from staff. Data were subjected to an intenton to treat analysis. Intergroup differences were evaluated with paired and unpaired t-test.
Results: At the 12-month visit, significant reductions in BP (mm Hg) were observed in both groups: (Group I, t = 0: systolic BP = 137.3 + 15.6, diastolic BP = 83.8 + 8.5; t = 12: systolic BP = 130.9 + 13.7, diastolic BP = 81.4 + 7.9; Group C t = 0: systolic BP = 138.1 + 12.4, diastolic BP = 84.7 + 6.8; t = 12 systolic BP = 134.0 + 10.8, diastolic BP = 82.5 + 6.5) (P < 0.001 in both cases). In group I, drug therapy decreased in 22.7% of the patients, increased in 11.7%, and was unchanged in 65.6%. Corresponding proportions in Group C were 12.1%, 32.6%, and 55.3%. The reduction in BP in group I was associated with better adherence to physicians' recommendations; that observed in group C was associated with increased use of antihypertensive drugs. In group I, drug expenditures decreased by a mean of EUR 3.15 per capita per month (versus EUR 1.80 per capita per month in Group C). Significant improvements were noted in some aspects of the lifestyle in both groups, but the SF-36 revealed better results for Group I patients.
Discussion and Conclusion: Therapeutic education is a powerful tool for improving blood pressure control. This experience highlights the importance of patient involvement in the management of hypertension.