A Pharmacist Intervention for Monitoring and Treating Hypertension Using Bidirectional Texting

摘要 在美国，高血压每年导致约395，000人死亡：每六个死亡中就有一个。 在美国，高血压是仅次于吸烟的第二大可改变的死亡原因。血压差（BP） 控制会增加心肌梗死、中风和死亡的风险，通常是由于治疗延误 强化我们开发了一种远程医疗服务，称为集中式医疗保健解决方案， 成功地远程向私人医生办公室提供临床药学服务，特别是在小型 医疗机构和农村地区。在我们之前的工作中，我们证明了一个医生-药剂师 合作可以有效地降低血压，但药剂师花费了相当大的时间， 获得并聚集患者的家庭BP测量值。因此，我们开发了一个额外的M- 一种叫做“你的血压是多少”的健康解决方案（WyBP），一个定制的双向SMS（短消息 服务或短信）平台。WyBP价格低廉（即，无需投资智能手机 技术，或WiFi），广泛的患者（包括老年人和农村人口）可接受， 可扩展到在忙碌临床环境中观察到的受试者体积，并易于集成到典型诊所中 工作流程。在两个试点中，我们证明了高依从率，表明患者愿意， 能够将血压测量值带回家并将其发送给我们的研究团队。这份提案结合了我们两个 以前的努力，使用远程定位药剂师和双向短信，以提高效率，减少 成本和改善获得一个专门的药剂师。我们知识上的一个主要空白是 一个“虚拟”的团队成员可以通过家庭血压监测技术支持，特别是 在小型医疗机构。本提案的目标是评估我们的可扩展SMS方法是否 结合基于药剂师的干预措施，有效地改善了血压管理。实现这一 目标，我们将确定我们的干预是否导致血压下降;确定我们的干预是否导致 强化治疗;并确定干预的成本效益。于年底 项目，我们希望为农村高血压患者提供一种新颖，可扩展和具有成本效益的治疗方法 通过扩大集中式医疗保健的可行性、可扩展性和传播， 解决方案干预。干预具有重要意义

ABSTRACT Hypertension causes an estimated 395,000 deaths in the US each year: one out of every six deaths. Hypertension is second only to smoking as a modifiable cause of death in the US. Poor blood pressure (BP) control increases the risk of myocardial infarction, stroke and death and is often due to delays in treatment intensification. We have developed a telehealth service called Centralized Healthcare Solutions that has successfully delivered clinical pharmacy services remotely to private physician offices, especially in small medical offices and rural locations. In our prior work, we demonstrated that a physician-pharmacist collaboration could cost effectively reduce BP, but pharmacists spent a considerable proportion of their time obtaining and aggregating patients' home BP measurements. Thus, we have developed an additional m- health solution called What's your BP? (WyBP), a custom- built bi-directional SMS-based (short message service, or texting) platform. WyBP is inexpensive (i.e., does not require investment in smartphone technology, or WiFi), acceptable to a broad range of patients (including the elderly and rural populations), scalable to subject volume observed in busy clinical settings, and easily integrated into typical clinic workflows. In two pilots, we demonstrated a high rate of adherence, indicating that patients were willing and able to take home BP measurements and send them to our research team. This proposal combines our two prior efforts to use remotely located pharmacists and bi-directional texting to improve efficiencies, reduce cost and improve access to a dedicated pharmacist. A major gap in our knowledge is whether the potency of a “virtual” team member can be improved by home BP monitoring with technological support, especially in small medical offices. The goal of this proposal is to evaluate whether our scalable SMS approach combined with a pharmacist-based intervention improves BP management cost effectively. To achieve this objective, we will determine if our intervention leads to decreases in BP; determine if our intervention leads to intensification of therapy; and determine the cost effectiveness of the intervention. At the end of this project, we expect to provide a novel, scalable and cost-effective approach for treating hypertension in rural populations by expanding the feasibility, scalability and dissemination of the Centralized Healthcare Solutions intervention. The intervention has important