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Table 6 Study implementation issues

From: Hypertension Improvement Project (HIP): study protocol and implementation challenges

Challenge Solution
Setting  
Access to clinic space for study visits Schedule study visits on days when clinic rooms are available.
Access to space for group intervention Schedule evening sessions; find local facility.
Minimize disruption to practice flow Study staff responsible for scheduling, check-in, and posting of signage.
Engage clinic staff/communication Group meeting prior to (and early part) of implementation; use of e-mail; financial compensation to offset practice costs.
Travel to distant sites Staff coordinate travel together to minimize travel costs.
Patient population/recruitment  
Enroll low SES population Target participants with no insurance, with Medicaid or Medicare without supplemental insurance.
Identify minority population Target clinics with more minority participants.
Recruit men to participate Prioritize mailings and phone calls to men.
High proportion of participants at BP goal (clinics are doing well in BP management; volunteer bias) Chart review to identify patients with uncontrolled BP prior to screening for Cohort 4.
Group intervention  
Finding patients motivated to undergo group intervention Recruitment by opt-out changed to opt-in/opt-out method.
Attendance Useful information; mimics real-world implementation.
No individualized counseling (allows implementation in busy setting) Use community health advisors.
Physician intervention  
MD turnover Refer participants to another participating provider within practice.
Additional work for CPM form completion Form on non-carbon paper to use as clinic note; brief 1-page form; top part can be filled out by non-MD.
MD time for training module completion Face-to-face orientation of providers to Web-based (asynchronous) training modules; CME credits offered.
QI developed by researchers (non-practice staff); competing QI initiatives within practice In future, increase involvement of practice clinicians; use of electronic records to collect BP at routine visits.
Town-gown relationship Work with existing research partner (PCRC).
  1. BP = blood pressure; CME = continuing medical education; CPM = clinical performance measure; QI = Quality Improvement; JNC = Joint National Committee on Prevention, Evaluation, Detection, and Treatment of High Blood Pressure; MD = physician; PCRC = Primary Care Research Consortium; SES = socioeconomic status.
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