The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial
The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial
复制标题
DOI：
10.1186/1471-2458-9-456
复制
发表时间：
2009-12-10
影响因子：
4.5
通讯作者：
Bodenheimer, Thomas
中科院分区：
文献类型：
--
作者：
Bennett, Heather;Laird, Kelsey;Bodenheimer, Thomas
背景：尽管有许多抗高血压药物可用，但三分之二的高血压患者不能实现血压控制。这被认为是由于患者教育不足，药物依从性差和“临床惰性”的综合作用。“本试验评估了一种干预措施，包括健康指导，家庭血压监测和家庭药物滴定作为一种方法，以解决这三个原因的高血压控制不良。方法/设计：随机对照试验将包括300例控制不良的高血压患者。参与者将从一家主要为低收入人群服务的教学医院的初级保健诊所招募。一个由150名参与者组成的干预组将在6个月内接受健康指导，家庭血压监测和抗高血压药物的家庭滴定。对照组（n = 150）将接受健康指导和家庭血压监测，持续相同的时间。被动对照组将接受常规护理。将在基线、6个月和12个月后进行血压测量。主要结局将是6个月和12个月后收缩压的变化。测量的次要结果将是舒张压，不良事件，患者和供应商satisfaction.Discussion的变化：本研究旨在评估是否健康指导，家庭血压监测和家庭药物滴定的三管齐下的方法可以成功地改善血压，如果是这样，这种效果是否持续超过干预期间。
Background: Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control.Methods/Design: The randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n = 150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction.Discussion: The present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention.