MD, Internal Medicine - Pediatric Resident - PGY1 starting July 1st, 2022

Context. A major component of the management of uncontrolled hypertension (HTN) in African Americans involves patient’s adopting self-management behaviors related to diet, physical activity, medication-taking, and self-monitoring of BP. The Patient Assessment of Chronic Illness Care (PACIC) is a tool used to assess patient experiences in the office related to the management of their hypertension and other chronic diseases and can be an estimate of patient perceived support from their providers.

Objective. The authors investigated the relationship between patient self-reported facilitation of goal setting during primary care visits and the number and type of self-reported goals set.

Study Design/Analysis. Cross-sectional study using data at baseline from two arms of a cluster randomized trial designed to investigate optimal strategies for improving blood pressure (BP) control.

Setting. 32 rural primary care practices in Alabama and North Carolina.

Population. African American adults with a history of uncontrolled hypertension (elevated in chart review over last 1 year and at baseline visit).

Instrument. Patient Assessment of Care for Chronic Conditions (PACIC) and patient reported goal setting using validated instruments. Research grade BP measured in practice setting.

Outcome Measures: Primary = Mean number of self-reported self-management goals set in last six months.

Results. Overall, 1438 patients with complete baseline data reported setting a mean of 3.9 ± 2.2 goals/person with no significant difference by age or gender but with higher education levels being significantly associated with significantly more goal setting. There was a positive correlation between number of goals set and PACIC total mean score (r =.249, p < .001). In multivariate analyses, mean total PACIC score remained significantly associated with higher goal setting even when controlling for age, gender, education, and income (Exp β = 2.08; 95% CI = 1.64 – 2.64).

Conclusions. These findings demonstrate that adult patients with a history of uncontrolled hypertension who reported more emotional and instrumental support from practice personnel, as measured by the mean PACIC score, were more likely to set a higher number of self-management goals.