Development of an implementation-ready antihypertensive self-titration intervention to improve US blood pressure control

近二分之一的美国成年人患有高血压，高血压是心肌梗死的主要原因， 中风和死亡。尽管高血压的重要性和广泛的可得性 在药物治疗方面，2018年只有44%的患者血压得到了控制。这是在 部分原因是我们提供护理的方式，需要新的战略来实现更好的效果 血压控制。由非内科医生进行药物滴定的团队护理是一种 这一方法前景看好，但所需的成本和基础设施使这一选择变得不太可行。一个 另一种策略是让患者通过检查血液来自我管理自己的高血压 压力，并遵循患者和初级保健医生之间预先计划的算法， 在家里加强他们的药物治疗。尽管有证据表明这种方法的有效性和成本- 这种方法的有效性，它还没有被纳入常规护理。 在这个项目中，我们建议开发一种可实施的抗高血压自我滴定 通过定性访谈和现实世界的降压评估进行干预 坚持不懈。拟议的目标是：(1)探讨执行的障碍和促进者 抗高血压自我滴定在美国常规初级保健中的应用；(2)评估遵守 抗高血压治疗；以及(3)开发一种可实施的抗高血压自我 滴定协议，进行可用性测试，并准备一个务实的，随机的建议 试验以测试干预的有效性。该项目的总体目标是开发一种 有潜力改善血液的高血压护理创新替代模式 压力控制、患者自我效能感和疾病理解 Haff博士是一名执业的初级保健医生，致力于研究改善 预防和治疗心脏代谢性疾病，该提案包括一项培训计划 这将加速她在实施科学、定性和定量领域的职业发展 方法、卫生服务研究方法和科学写作。导师团队，由 Niteesh Choudhry，卫生服务研究和实施科学专家，与 心脏代谢性疾病，包括预防心脏病学的知名专家(Paul Ridker，共同 导师)、生物统计学(罗伯特·格林，共同导师)以及实施科学和定性 方法(共同导师Karen Emmons)，并将确保成功完成拟议的 项目和培训。到这个项目结束时，哈夫博士将能够独立 设计、确定和评估心脏代谢性疾病的干预措施。评选结果 拟议的K23将是计划中的R01级应用程序的宝贵试点工作。

Nearly 1 in 2 US adults has hypertension, and it is a leading cause of myocardial infarction, stroke, and death. Despite the importance of hypertension and the widespread availability of medication treatment, only 44% of patients had controlled blood pressures in 2018. This is in part due to the way in which we deliver care, and new strategies are needed to achieve better blood pressure control. Team-based care with medication titration by a non-physician is a promising approach, but the cost and infrastructure required make this option less feasible. An alternative strategy is to have patients self-manage their own hypertension by checking blood pressures and following an algorithm, pre-planned between the patient and primary care doctor, to intensify their medications at home. Despite evidence for the effectiveness and cost- effectiveness of this approach, it has not yet been incorporated into routine care. In this project, we propose to develop an implementation-ready antihypertensive self-titration intervention informed by qualitative interviews and real-world assessments of antihypertensive adherence. The proposed aims are to: (1) explore barriers and facilitators to the implementation of antihypertensive self-titration in routine US primary care; (2) assess adherence to antihypertensive treatments; and (3) develop an implementation-ready antihypertensive self- titration protocol, perform usability testing, and prepare a proposal for a pragmatic, randomized trial to test the intervention’s effectiveness. The overarching goal of the project is to develop an innovative alternative model of hypertension care that has the potential to improve blood pressure control, patient self-efficacy, and disease understanding Dr. Haff is a practicing primary care physician committed to a career in research to improve the prevention and treatment of cardiometabolic disease, and this proposal includes a training plan that will accelerate her career development in the areas of implementation science, qualitative methods, health services research methods, and scientific writing. The mentorship team, led by Niteesh Choudhry, an expert in health services research and implementation science related to cardiometabolic disease, includes well-known experts in preventive cardiology (Paul Ridker, co- mentor), biostatistics (Robert Glynn, co-mentor), and implementation science and qualitative methods (Karen Emmons, co-mentor), and will ensure successful completion of the proposed project and training. By the conclusion of this program, Dr. Haff will be able to independently design, target, and evaluate interventions for cardiometabolic disease. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.