Hypertension and Adherence in Rural Practice

描述（由研究者提供）：高血压（HTN）是 中风、冠心病（CHD）的流行、可改变的风险因素， 充血性心力衰竭（CHF）。非裔美国人和低收入者 教育和收入水平是HTN相关的最大风险 发病率和死亡率。只有11%的HTN患者 控制，估计不遵守从20- 90%。这一拟议 4-一项为期一年的项目是一项随机临床试验， 理论驱动的多组分药物依从性促进干预 坚持在低收入，主要是非洲裔美国人，居民的样本 正在接受药物治疗的亚拉巴马农村人。的样品 将从入组研究的患者人群中招募426例患者， ADPH HTN管理计划。参与者将被随机分配到其中一个 两种治疗条件：依从性促进（AP）干预或癌症 信息控制。这两种情况都涉及一系列的家访， 由训练有素、经验丰富的社区卫生服务人员进行电话随访 顾问（CHA.）。AP治疗条件是一个理论驱动的，多成分的 利用交互式软件指导CHA和参与者的干预 通过半结构化对话，结合个性化评估， 定制反馈，旨在帮助患者发展行为管理技能 可用于维持药物使用的一致模式和定期 在预约的诊所就诊。CI控制条件将 利用非交互式软件指导CHA和参与者通过 半结构化对话，讨论常见癌症的一般信息 以及与癌症预防和控制相关的标准建议。的 主要结局，处方抗高血压药物的药丸计数，将 在3个月、6个月、9个月和12个月随访时收集。患者自我报告 坚持和出席预约，以补充处方， 抗高血压药物将作为次要指标进行检查， 治疗依从性。一些与依从性相关的指标（血压、症状和 副作用，对HTN和药物使用的态度，抑郁症）也将被 获得检查的理论结构解决的发展， AP干预并检查与反应相关的患者特征 接受治疗

DESCRIPTION (provided by investigator): Hypertension (HTN) is the most prevalent, modifiable risk factor for stroke, coronary heart disease (CHD), and congestive heart failure (CHF). African-Americans and individuals with low educational and income levels are at the greatest risk for HTN-related morbidity and mortality. As few as 11 percent of HTN patients are adequately controlled, with estimates of non-adherence from 20-90 percent. This proposed 4-year project is a randomized clinical trial evaluating the effect of a theory-driven, multi-component adherence promotion intervention on medication adherence in a sample of low-income, predominantly African-American, residents of rural Alabama who are receiving pharmacologic treatment for HTN. A sample of 426 patients will be recruited from the population of patients enrolled in the ADPH HTN Management Program. Participants will be randomly assigned to one of two treatment conditions: Adherence Promotion (AP) intervention or Cancer Information (CI) control. Both conditions involve a series of home visits and follow-up phone calls conducted by a trained and experienced Community Health Advisor (CHA.). The AP treatment condition is a theory-driven, multi-component intervention utilizing interactive software to direct the CHA and participant through a semi-structured dialogue incorporating individualized assessment and tailored feedback intended to help patients develop behavior management skills that can be used to maintain consistent patterns of medication use and regular attendance at scheduled clinic appointments. The CI control condition will utilize non-interactive software to direct the CHA and participant through a semi-structured dialogue addressing general information about common cancers and standard recommendations relevant to cancer prevention and control. The primary outcome, pill counts for prescribed antihypertensive medications, will be collected at 3-, 6-, 9-, and 12-month follow-up. Patient self-reported adherence and attendance at appointments to refill prescriptions for antihypertensive medications will be examined as secondary measures of treatment adherence. A number of adherence-related measures (BP, symptoms and side effects, attitudes about HTN and medication use, depression) will also be obtained to examine theoretical constructs addressed in the development of the AP intervention and to examine patient characteristics associated with response to treatment.