Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control - A randomized controlled trial
Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control - A randomized controlled trial
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DOI：
10.1001/jama.299.24.2857
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发表时间：
2008-06-25
影响因子：
120.7
通讯作者：
Thompson, Robert S.
中科院分区：
文献类型：
--
作者：
Green, Beverly B.;Cook, Andrea J.;Thompson, Robert S.
背景治疗高血压降低了心血管疾病的死亡率和致残率，但大多数高血压仍然没有得到充分的控制。目的确定一种使用患者网络服务、家庭血压监测和药剂师辅助护理的新护理模式是否能改善血压控制。设计、设置和参与者一项三组随机对照试验，电子通信和家庭血压监测研究基于慢性护理模式。这项试验是在华盛顿州的一个综合团体实践中进行的，招募了778名年龄在25岁至75岁之间、患有未受控制的高血压和互联网接入的参与者。从2005年6月到2007年12月，通过一个安全的患者网站提供护理。干预参与者被随机分配到常规护理、家庭血压监测和安全患者网站培训，或者家庭血压监测和安全患者网站培训加上药剂师护理管理。主要结果衡量控制血压(<；140/90 mm Hg)的患者百分比以及12个月时收缩压和舒张压的变化。结果在778名患者中，730名(94%)完成了为期1年的随访。与常规护理(36%[95%可信区间，30%-42%]比31%[95%可信区间，25%-37%])相比，被分配到家庭血压监测和网络训练组的患者控制血压的百分比(<；140/90 mm Hg)无显著增加；P=。21)。在家庭血压监测和网络培训中加入基于网络的药剂师护理，与常规护理相比，显著增加了患者控制血压的比例(56%；95%可信区间，49%-62%)(P
Context Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled.Objective To determine if a new model of care that uses patient Web services, home blood pressure ( BP) monitoring, and pharmacist- assisted care improves BP control.Design, Setting, and Participants A 3- group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007.Interventions Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications.Main Outcome Measures Percentage of patients with controlled BP ( < 140/90 mm Hg) and changes in systolic and diastolic BP at 12 months.Results Of 778 patients, 730 ( 94%) completed the 1- year follow- up visit. Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP ( < 140/90 mm Hg) compared with usual care ( 36% [ 95% confidence interval {CI}, 30%- 42%] vs 31% [ 95% CI, 25%-37%]; P=. 21). Adding Web- based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP ( 56%; 95% CI, 49%- 62%) compared with usual care ( P