Self-management of blood pressure medication for hypertensive veterans

高血压退伍军人的血压药物自我管理

基本信息

批准号：
10290890
负责人：
Dena Evette Rifkin
金额：
--
依托单位：
VA SAN DIEGO HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10290890
关键词：
Address Adherence Adverse event Algorithms Ambulatory Blood Pressure Monitoring Blood Pressure Blood Pressure Monitors Cardiovascular Diseases Caring Clinic Clinic Visits Clinical Clinical Research Cohort Studies Custom Dose Effectiveness Emergency department visit Goals Health Health Services Research Healthcare Healthcare Systems Home Home Blood Pressure Monitoring Hospitalization Hour Hypertension Intervention Kidney Kidney Diseases Literature Measurement Medical Medical Records Methods Monitor Myocardial Infarction Outcome Outcome Measure Participant Patient-Focused Outcomes Patients Pharmaceutical Preparations Population Primary Health Care Protocols documentation Provider Randomized Randomized Controlled Clinical Trials Safety San Francisco Scheme Self Efficacy Self Management Serious Adverse Event Specific qualifier value System Testing Veterans Visit arm base blood pressure medication blood pressure regulation care delivery care providers clinical center effective therapy follow-up hypertension control hypertension treatment improved novel strategies patient oriented prevent safety outcomes secondary outcome stroke risk tool treatment arm treatment as usual treatment center treatment strategy usual care arm

项目摘要

Anticipated Impact on Veterans’ Healthcare: Hypertension is the most common medical problem among US Veterans. Treatment is available and effective, but control rates remain under 75%. While blood pressure control has traditionally been achieved through sequential visits and medication changes initiated by providers during office-based care, self-monitoring and self-management of blood pressure medication is an important strategy that would empower Veterans to achieve better control of blood pressure. The health impacts of better systems for treatment of hypertension are significant, including decreased rates of cardiovascular and kidney disease. Project background: Recent literature from the UK (TASMINH2 and TASMIN-SR trials) have suggested that patient-driven self-management of blood pressure medications can be effective in achieving hypertension control, but questions remain as to how to apply these findings to a US population. The VA Healthcare System is an ideal system in which to test and customize this strategy for blood pressure treatment. Project objectives: We propose to address the following simple and powerful clinical research question: Is patient-initiated self-management of blood pressure medication using a pre-specified, generalizable dose escalation scheme clinically effective, safe, and acceptable to patients and clinicians, compared to usual care in controlling blood pressure in hypertensive veterans? Project methods: We propose a 12-month randomized, controlled, non-blinded, single-center study of patient-initiated self-management of blood pressure medication vs. usual care with planned post- study cohort follow-up via medical records. Participants in the intervention arm will be provided with home blood pressure monitoring tools and a self-management algorithm for changing their blood pressure medications as needed. Participants in the usual care arm will receive home monitoring tools and typical hypertension care from the primary care provider. The primary blood pressure outcome measure for the study will be between-group change in in-clinic blood pressure. Acceptability, safety, patient-centered outcomes and adherence will be key secondary outcomes.

对退伍军人医疗保健的预期影响：高血压是最常见的医疗问题美国退伍军人。治疗可用且有效，但控制率仍低于75％。尽管传统上，血压控制是通过顺序访问和药物来实现的提供者在基于办公室的护理，自我监控和自我管理期间发起的更改血压药物是一种重要的策略，将使退伍军人能够取得更好的成就控制血压。更好系统治疗高血压的健康影响是重要的是，包括心血管和肾脏疾病率降低。项目背景：来自英国的最新文献（Tasminh2和Tasmin-SR试验）已有建议以患者为导向的血压药物自我管理可以有效实现高血压控制，但有关如何将这些发现应用于美国的问题仍然存在人口。 VA医疗保健系统是一个理想的系统，可以在其中测试和自定义血压治疗策略。项目目标：我们建议解决以下简单而强大的临床研究问题：是否使用预先指定的，可推广的患者引发的血压药物自我管理剂量升级方案在临床上有效，安全和可接受的患者和临床医生可以接受在控制高血压退伍军人的血压方面通常要注意？项目方法：我们提出了一个12个月的随机，受控，非盲人，单中心研究患者发起的血压药物的自我管理与计划后的通常护理通过医疗记录学习队列随访。干预部门的参与者将提供家庭血压监测工具和自我管理算法改变血液根据需要进行压力药物。通常的护理部门的参与者将获得家庭监控初级保健提供者的工具和典型的高血压护理。初级血压该研究的结果度量将是临床内血压的组间变化。可接受性，安全性，以患者为中心的结果和依从性将是关键的次要结果。