What strategies ensure attainment of treatment goals?

From the Guidelines

To ensure attainment of treatment goals, a comprehensive approach that includes maintaining lifestyle therapy, using initial combination therapy if necessary, and regularly assessing adherence to medications and dietary sodium is crucial. This approach is supported by the most recent and highest quality study, which emphasizes the importance of individualizing treatment based on patient characteristics and maintaining diastolic blood pressure above 60 mm Hg in older adults with diabetes 1.

Key Strategies for Goal Attainment

• Maintain lifestyle therapy, including dietary changes and regular physical activity
• Use initial combination therapy if blood pressure is >20/10 mm Hg above goal
• Add medications as needed to reach goal, and use combination products to foster adherence
• Assess adherence with medications and dietary sodium regularly
• Individualize treatment based on patient characteristics, such as age and comorbid conditions

Importance of Regular Assessment and Feedback

Regular progress tracking and feedback are essential for achieving treatment goals. This can be done through daily or weekly reviews, using tools like journals, apps, or spreadsheets to monitor advancement 1. Additionally, home blood pressure devices can be useful in involving patients in their own care, but it is essential to calibrate these devices and consider the difference between home-determined and office blood pressure readings.

Patient-Centered Care and Adherence

Patient satisfaction with their healthcare providers predicts compliance with treatment, highlighting the importance of patient-centered care 1. Strategies such as cognitive-behavioral therapy, motivational interviewing, and addressing cultural and social context variables can facilitate behavior change and improve adherence to treatment regimens. By prioritizing patient-centered care and using a comprehensive approach to treatment, healthcare providers can help patients achieve their treatment goals and improve overall outcomes.

From the FDA Drug Label

The primary endpoint was the time to first occurrence of one of the following events: hospitalization for angina pectoris, coronary revascularization, myocardial infarction, cardiovascular death, resuscitated cardiac arrest, hospitalization for heart failure, stroke/TIA, or peripheral vascular disease. A total of 110 (16. 6%) and 151 (23.1%) first events occurred in the amlodipine besylate tablets and placebo groups, respectively, for a hazard ratio of 0.691 (95% CI: 0.540 to 0.884, p = 0. 003).

The strategies that ensure attainment of treatment goals with amlodipine include:

• Standard care that includes aspirin, statins, beta-blockers, nitroglycerin, anti-coagulants, and diuretics, but excludes other calcium channel blockers.
• Dosing of 5 to 10 mg once daily.
• Monitoring for hospitalizations for angina and revascularization procedures.
• Long-term dosing to demonstrate sustained efficacy in angina patients 2.

From the Research

Strategies for Attainment of Treatment Goals

To ensure the attainment of treatment goals, several strategies can be employed:

• Goal Attainment Scaling (GAS): GAS is an individualized outcome measure that allows the setting of personalized treatment goals 3, 4, 5. It has been proven to be a useful instrument for quality assurance as it helps with setting and monitoring goals and sub-goals.
• Patient-Centered Care: New efforts have begun to transform healthcare to focus on patient-centered care, which can be facilitated by eliciting, operationalizing, and measuring the attainment of patient-identified goals of healthcare 6.
• Shared Decision-Making (SDM): SDM is an essential part of complex care, and goal setting should be recognized as a core aspect of this approach 7. Clinicians should explicitly include goal setting as an integrated component of SDM.
• Setting Personalized Goals: Setting personalized goals based on individual priorities and measuring progress can be an effective way to attain treatment goals 5. This approach allows individuals to set goals based on their own priorities and measure progress.
• Using Standardized Approaches: Standardized approaches to measuring goal-based outcomes, such as GAS and patient-reported outcome measures (PROM), can be used to assess goal attainment 5. These approaches can be successfully implemented in a non-randomly selected population.

Key Considerations

When implementing these strategies, several key considerations should be taken into account:

• Individualized Goals: Goals should be individualized and based on the patient's priorities and needs 3, 5.
• Collaborative Goal Setting: Goal setting should be a collaborative process between the patient and clinician 7.
• Monitoring Progress: Progress towards goals should be regularly monitored and assessed 3, 5.
• Flexibility: The approach to goal attainment should be flexible and adaptable to the individual's changing needs and priorities 4.