Electronic Communications and Home B.P. Monitoring

描述（由申请人提供）：尽管有基于证据的国家认可的治疗指南和30年的研究，但高血压患者的血压（BP）的药物控制一直是难以捉摸的。目前，只有不到50%的已知高血压患者得到了充分控制。如果血压控制得到改善，心血管疾病发病率和死亡率将显著降低。我们建议进行一项随机对照试验，研究应用慢性护理模式（CCM）改善高血压控制的有效性。我们将选择一组接受降压药物治疗的高血压患者，这些患者可以使用互联网和电子邮件，并且血压控制不佳（血压140/90）。愿意参与的受试者将被随机分配到三个干预组之一：1组（UC）将接受高血压常规护理。这包括访问GHC已经提供的安全内部网服务（包括卫生图书馆、消息传递和处方补充服务）；第二组（BPM）将额外获得家庭血压计，其使用指导，以及基于网络的沟通能力培训课程；或第3组（BPM+RX），他们将接受上述所有内容，以及临床药剂师通过网络提供的计划和主动、自我和护理管理支持。我们的研究假设是，BPM+Rx将被证明比UC或BPM在改善以下主要结局方面更有效：(1)平均舒张压、收缩压以及舒张压和收缩压的联合平均值的变化；(2)血压得到充分控制的患者比例（定义为血压等于或小于140 mmHg收缩压和等于或小于90 mmHg舒张压）。

DESCRIPTION (provided by applicant): The control of blood pressure (BP) for patients with hypertension on medications has been elusive, despite the availability of evidence-based nationally recognized guidelines for treatment and 30 years of research addressing this. At present less than 50% of patients with known hypertension are adequately controlled. If BP control could be improved, significant decreases in cardiovascular morbidity and mortality would occur. We propose to conduct a randomized controlled trial of the effectiveness of applying the Chronic Care Model (CCM) to improve hypertension control. We will identify a cohort of Group Health Cooperative patients with hypertension on anti-hypertensive medications, who have access to the Internet and E-mail, and who have poorly controlled blood pressure (BP > 140/90). Subjects willing to participate will be randomly assigned to one of three intervention arms: Group-1 (UC) will receive usual care for their hypertension. This includes access to secure Intranet services already available at GHC (including a health library, messaging, and prescription refill services); Group-2 (BPM), will additionally receive home blood pressure monitors, instruction on their use, and a proficiency training session on Web-based communication; or Group-3 (BPM+RX), who will receive all of the above plus planned and proactive, self and care management support provided by clinical pharmacists via the Web. Our study hypothesis is that BPM+Rx will prove to be more efficacious than UC or BPM in improving the following primary outcomes: (1) change in mean diastolic, systolic, and the combined average of diastolic and systolic blood pressure and (2) proportion of patients with adequately controlled blood pressure (defined as a BP of equal to or <140 mmHg systolic and equal to or <90 mmHg diastolic).