Long-Term Outcomes and Costs of Web-Based Hypertension Care (e-BPLT)

描述(由申请人提供)：基于网络的高血压护理高血压(HTN)的长期结果和成本在美国是最常见的慢性疾病，几乎每3个成年人中就有一个受到影响；然而，大多数人仍然没有得到充分的治疗。以临床为基础的卫生服务干预在降低BP和改善HTN控制方面取得了成功。然而，在这些影响的持久性方面，科学文献和政策经验方面存在差距。了解成功干预的长期影响对于HTN治疗尤其重要，在HTN治疗中，通过持续降低血压来实现最大的健康益处--通过降低死亡率、心血管事件和肾功能衰竭来衡量。我们建议根据一项随机试验的结果，e-BP：电子通信和家庭血压监测研究(R01 CA075263-01A1，B.Green，PI)的结果，研究基于网络的沟通干预改善血压控制的长期有效性。在这项三臂研究中，未控制HTN的患者被随机分配到常规护理或接受家庭血压监测仪和培训，以使用现有的集成患者网络门户，或通过网络提供这种加药房护理。12个月后，接受网络药剂师帮助的患者控制BP的可能性几乎是常规护理的2倍。超过92%的随机患者在最后一次随访评估后12个月仍在Group Health范围内登记。鉴于集团健康参与者退保的历史模式，我们预计超过75%的试验参与者将在研究结束后总共5年内继续参加健康计划，从而使我们能够评估干预措施对BP和成本的长期影响。因此，我们提出了以下目标：目标1：评估干预结束后随着时间的推移，治疗结果、收缩压、舒张压和血压控制的持久性。目的#2：评估以下方面的长期变化：(1)抗高血压药物处方的数量和依从性；(2)安全消息的使用；(3)随着时间的推移使用家庭血压监测仪。目的#3a：分析随机分组后至少5年内参与e-BP试验的患者的卫生服务利用和成本的长期变化。目标#3b：使用长期HTN对照分析的结果-目标1，以及长期卫生保健成本的变化-目标3a，估计药房干预的长期增量成本效果。 公共卫生相关性：基于网络的高血压护理高血压(HTN)的长期结果和成本在美国是一种常见的慢性疾病，几乎三分之一的成年人受到影响；然而，大多数人仍然没有得到充分的治疗。最近的一项研究表明，通过为患者提供家庭血压监测仪、用于与他们的医疗团队沟通的基于网络的资源以及药剂师对药物的帮助，HTN的控制可以得到改善。然而，目前尚不清楚在研究结束后，HTN控制是否持续，医疗费用是否下降。我们将研究基于网络的HTN干预对血压和医疗费用的长期影响。

DESCRIPTION (provided by applicant): Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is the most common chronic condition in the U.S., affecting almost 1 in 3 adults; however, it remains inadequately treated in most. Clinic-based health services interventions have achieved success in reducing BP and improving HTN control. There is however, a gap in the scientific literature and policy experience regarding the durability of these effects. Understanding the long-term impact of a successful intervention is of particular importance for HTN treatment where the greatest health benefits-as measured by decreased mortality, cardiovascular events, and renal failure are achieved by persistent reductions in BP. We propose to study the long-term effectiveness of a Web-based communication intervention to improve BP control based on the results of a randomized trial, e-BP: Electronic Communications and Home Blood Pressure Monitoring Study (R01 CA075263-01A1, B. Green, PI). In the 3-arm study patients with uncontrolled HTN were randomized to usual care or to receive home BP monitors and training to use an existing integrated patient Web portal, or this plus pharmacy care delivered over the Web. After 12 months, patients receiving Web- based pharmacist assistance were almost 2 times as likely to have controlled BP compared to usual care. Over 92% of the patients' randomized are still enrolled within Group Health more than 12 months after the last follow-up assessment. Given historical patterns of disenrollment among Group Health enrollees we anticipate over 75% of trial participants will remain with the health plan for a total of 5 years after the study's end, allowing us to assess the long-term effects of the interventions on BP and costs. Thus we propose the following aims: Aim #1: To evaluate the durability of treatment outcomes, systolic BP, diastolic BP, and BP control over time after the intervention ended. Aim #2: To evaluate long-term changes in: (1) the number of and adherence to anti-hypertensive medications prescribed; (2) use of secure messaging; and (3) use of home BP monitors over time. Aim #3a: To analyze long-term changes in health services utilization and cost among patients participating in the e-BP trial for at least 5 years following randomization Aim #3b: To estimate the long-term incremental cost effectiveness of the pharmacy intervention using results from the analysis of long-term HTN control-Aim 1, and changes in long-term health care costs-Aim 3a. PUBLIC HEALTH RELEVANCE: Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is a common chronic condition in the United States, affecting almost 1 in 3 adults; however, it remains inadequately treated in most. A recent research study showed that HTN control could be improved by providing patients with home blood pressure monitors, Web-based resources to communicate with their health care team, and pharmacist assistance with medications. However it is unknown whether HTN control persisted and health care costs decreased after the study ended. We will study the long-term effects of a Web-based HTN intervention on blood pressure and health care costs.