New Strategies to Enhance Drug Adherence in Hypertension

描述（由研究者提供）：坚持降压 由于与患者有关的问题，药物通常很差， 医生和他们互动的医疗保健系统。这些问题 在服务不足的人群中，情况通常更糟。该项目旨在 护士个案管理系统（NCM），已被证明是有效的，在临床 高血压和其他慢性病的试验，在不同的地点， 公共支持的健康计划中医疗服务不足的人群。超过 这些人中有80%是少数民族，许多人生活在贫困之中： 90%的人能说流利的英语、西班牙语或越南语。需要输血的病人 根据JNC VI标准的降压药物被随机接受 单独常规护理或常规护理加NCM。后者包括一个初始 与患者及其家属进行面对面的教育会议， 护士发起的电话联系，在指定的时间间隔，以加强 教育信息和滴定药物治疗根据一个标准化的 议定书所有患者都接受电子血压测量设备 和药物依从性。定期血压报告邮寄至 患者及其医生，但未提供药物依从性数据， 医生、病人或护士。治疗期为6个月;血液 然后从所有病人身上收回压力监测器。在随后的 6-治疗后随访1个月，患者继续监测药物 坚持。主要假设是：坚持使用降压药物 接受常规护理和NCM联合治疗的患者中的比例高于接受常规护理和NCM联合治疗的患者 在那些只接受常规护理的人中。主要的结果指标是药物 由电子设备测量的粘附性。次要结局包括血液 压力，健康相关的生活质量，提供 特殊干预和患者及医生满意度。共有326 将患者随机分配，两组各163例。功率计算 是基于检测到至少10%的药物依从性差异， 两个群体之间。护士个案管理的有效性论证 建议项目中的高血压可能有助于传播 这种针对全美服务不足人群的方法

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 The treatment period is 6 months; blood pressure monitors are then withdrawn from all patients.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.