A Pharmacist Intervention for Monitoring and Treating Hypertension Using Bidirectional Texting

摘要 据估计，美国每年有395,000人死于高血压：每6人中就有1人死于高血压。 在美国，高血压是仅次于吸烟的可改变的死因。血压低(BP) 控制会增加心肌梗死、中风和死亡的风险，通常是由于治疗的延误。 强化。我们已经开发了一项名为集中式医疗解决方案的远程医疗服务，该服务具有 成功地将临床药房服务远程提供给私人医生办公室，特别是在小型 医务室和农村地区。在我们之前的工作中，我们证明了一个内科医生兼药剂师 合作可以经济有效地降低BP，但药剂师花费了相当大一部分时间 获取并汇总患者的家庭血压测量结果。因此，我们开发了一种额外的m- 健康解决方案名为“你的血压是多少？”(WyBP)，基于短消息的定制双向短信 服务或短信)平台。WyBP价格低廉(即不需要在智能手机上投资 技术，或WiFi)，为广泛的患者(包括老年人和农村人口)所接受， 可根据繁忙的临床环境中观察到的受试者数量进行扩展，并轻松集成到典型的诊所中 工作流程。在两名飞行员中，我们展示了高依从率，表明患者愿意和 能够将血压测量结果带回家，并将其发送给我们的研究团队。这项建议结合了我们两个人 之前使用远程药剂师和双向短信来提高效率、减少 降低成本，并改善获得专职药剂师的机会。我们知识中的一个主要差距是 通过家庭BP监测和技术支持，可以提高虚拟团队成员的满意度，特别是 在小的医务室。该提案的目标是评估我们的可扩展短信方法 结合以药剂师为基础的干预，有效地提高了BP管理成本。要做到这一点 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 加强治疗；并确定干预的成本效益。在这个结束的时候 项目，我们希望为农村高血压的治疗提供一种新的、可扩展的和成本效益高的方法。 通过扩大集中式医疗保健的可行性、可扩展性和普及性来扩大人口 解决方案干预。这一干预具有重要的意义

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