Remote monitoring for Equity in Advancing Control of Hypertension (REACH)

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ProjectSummary/Abstract This NHLBI R01 proposal aims to launch an effectiveness-implementation hybrid randomized trial to adapt a multi-faceted hypertension (HTN) management program shown to work in integrated healthcare delivery systems to a safety net healthcare system (San Francisco Health Network). It is well known that racial/ethnic minorities and those from lower socioeconomic backgrounds are significantly more likely to be diagnosed with HTN as well as more likely to have uncontrolled hypertension. To improve HTN control – particularly during the COVID-19 pandemic and beyond – there is a need for greater patient engagement in self-management in everyday life, as well as improved patient-clinician communication about home blood pressure (BP) readings and potential changes in anti-hypertensive medications. Previous trials have shown that digital technologies, specifically home BP monitoring combined with enhanced digital patient-provider communication, significantly improve BP control -- and these are critical for remote BP management for all patients during the pandemic. However, disseminating these known best practices has proved challenging, particularly in safety net healthcare settings that serve patients with the highest burden of chronic illness. Despite high interest in using tools for digital healthcare communication, vulnerable patient populations are currently less likely to use home BP monitoring devices and existing portal websites to communicate with their healthcare providers and teams. Therefore, patient-provider communication interventions must include training/support and patient activation as essential components of adapting digitally-based home BP management programs into the safety net. In Aim 1 of this study, we will offer patients with uncontrolled HTN in-person training to support their use of home BP monitors, the online patient portal, and basics about text messaging and mobile phone applications. We will examine pre-post training changes in technology use overall, as well as by specific patient subgroups with known differences in technology uptake. In Aim 2 we will conduct a two-arm randomized clinical trial to assess the effectiveness of enhanced digital communication (text messaging to remind/support and portal messaging to develop action plans and remotely adjust anti-hypertensive medications) vs. usual care. Both groups will receive a smart home BP monitor, and the primary outcome will be BP control at 12 months. In Aim 3 we will use a mixed methods approach to evaluate key implementation outcomes, guided by the RE-AIM framework, of adapting this existing, evidence-based remote BP monitoring program.