New Strategies to Enhance Drug Adherence in Hypertension

描述(由研究人员提供)：坚持降血压 由于与患者相关的问题，药物治疗通常很差， 医生和他们相互作用的医疗保健系统。这些问题 在服务不足的人群中通常情况更糟。提议的项目是量身定做的 经临床验证有效的护士病历管理系统 高血压和其他慢性病的试验，在不同的地点，到 公共支持的健康计划的医疗服务不足的人口。多过 这些人中有80%是少数民族，许多人生活在贫困中： 90%的人精通英语、西班牙语或越南语。需要输血的病人 根据JNC VI标准的降压药物随机接受 常规护理单独或常规护理加NCM。后者由首字母组成 与患者及其家属面对面的教育会议，随后 护士在指定的时间间隔内启动电话联系，以加强 教育信息和根据标准化的标准滴定药物治疗 协议。所有患者都接受了测量血压的电子设备 以及家里的药物依从性。有关血压的定期报告将邮寄至 患者和他们的医生，但没有向 医生、病人或护士。疗程为6个月；采血 然后，所有患者的压力监测器都会被撤回。在随后的 治疗后6个月随访期，患者继续监测用药情况 坚持不懈。主要的假设是：坚持服用降压药 在接受常规护理和NCM相结合的患者中， 在那些单独接受常规护理的人中。主要的结果衡量标准是药物 通过电子设备测量的粘附性。次要结果包括血液 压力、与健康相关的生活质量、提供 特殊干预和患者和医生的满意度。共有326个 患者将被随机分为两组，每组163人。功率计算 是基于检测到至少10%的药物依从性差异 在这两组人之间。护理病历管理的有效性论证 在拟议的项目中预防高血压可能有助于传播 这一方法适用于全美服务不足的人群。

DESCRIPTION (provided by investigator): Adherence to blood pressure lowering medications is generally poor, due to problems that relate to patients, physicians and the medical care system in which they interact. These problems are generally worse among underserved populations. The proposed project tailors a nurse case management system (NCM) that has proven efficacious in clinical trials for hypertension and other chronic conditions, in various venues, to the medically underserved population of a publicly supported health plan. More than 80 percent of these individuals are ethnic minorities and many live in poverty: 90 percent are fluent in English, Spanish or Vietnamese. Patients needing blood pressure lowering drugs according to JNC VI criteria are randomized to receive usual care alone or usual care plus NCM. The latter consists of an initial face-to-face educational session with patients and their families followed by nurse-initiated phone contacts at specified intervals to reinforce the educational message and titrate drug therapy according to a standardized protocol. All patients receive electronic devices for measuring blood pressure and drug adherence at home. Periodic reports on blood pressure are mailed to patients and their physicians, but no drug adherence data are provided to physicians, patients or nurses. The treatment period is 6 months; blood pressure monitors are then withdrawn from all patients. During the subsequent 6-month post-treatment follow-up period, patients continue to monitor drug adherence. The primary hypothesis is: adherence to blood pressure medications is greater among patients receiving the combination of usual care and NCM than among those receiving usual care alone. The primary outcome measure is drug adherence measured by the electronic device. Secondary outcomes include blood pressure, health-related quality of life, program costs for providing the special intervention and patient and physician satisfaction. A total of 326 patients will be randomized, 163 to each of the two groups. Power calculations are based on detection of at least a 10 percent difference in drug adherence between the two groups. Demonstration of the efficacy of nurse case management of hypertension in the proposed project may facilitate the dissemination of this approach to underserved populations throughout the U.S.