Hypertension and Adherence in Rural Practice

描述(调查者提供)：高血压(HTN)是最多的 中风、冠心病(CHD)的普遍、可改变的危险因素 充血性心力衰竭。非裔美国人和低收入人群 教育和收入水平是与HTN相关的最大风险 发病率和死亡率。只有11%的HTN患者足够 受控，估计不遵守的比例在20%-90%之间。这项建议 为期4年的项目是一项随机临床试验，评估 理论驱动、多组分依从性促进用药干预 低收入居民(主要是非裔美国人)的坚持 来自阿拉巴马州农村，他们正在接受HTN的药物治疗。一个例子 将从登记的患者中招募426名患者 ADPH HTN管理计划。参与者将被随机分配到以下其中一组 两种治疗条件：依从性促进(AP)干预或癌症 信息(CI)控制。这两种情况都涉及一系列的家访和 由训练有素和经验丰富的社区卫生人员进行电话跟踪 顾问(查)。AP的治疗条件是一个理论驱动的、多成分的 使用交互式软件指导CHA和参与者的干预 通过半结构化对话结合个性化评估和 量身定做的反馈，旨在帮助患者培养行为管理技能 可以用来维持一致的用药模式和规律 按预定时间预约就诊。CI控制条件将 利用非交互软件引导CHA和参与者 关于常见癌症的一般信息的半结构化对话 以及与癌症预防和控制相关的标准建议。这个 主要结果，开出的降压药的药片数量，将 在3个月、6个月、9个月和12个月的随访中收集。患者自我报告 遵守和出席预约重新开具处方 降压药将作为次要措施进行检查 治疗依从性。一系列与遵守有关的措施(BP、症状和 副作用、对HTN的态度和用药、抑郁)也将是 获取以检查在开发 AP干预并检查与反应相关的患者特征 去接受治疗。

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.