Multilevel mobile health program to improve rural hypertension

高血压（HTN）是心血管疾病的主要可改变原因。外科医生2020 呼吁采取行动控制高血压阐述了多层次战略的重要意义， 社会决定因素和获得护理的机会，影响HTN的控制。农村人经历了额外的 农村保健鸿沟的挑战：与提供者的地理距离、社会隔离、有限的社会 资源，以及低卫生知识普及率高。我们开发并验证了一种基于智能手机的 家庭血压监测（HBPM）计划，称为MyBP，并已证明 MyBP成功地促进了HBPM的依从性，改善了血压（BP）控制，并提高了患者 订婚我们现在将MyBP改编为虚拟代理，称为MyBP教练，并利用我们的经验 与这样的代理人提供纵向健康教育，移情指导，监测，并适应 以患者为中心的辅导，以农村个人与心血管疾病。在这里，在病人咨询的指导下， 委员会，我们提供MyBP教练，以农村个人作为个性化的课程，以促进和支持 高血压管理;高血压教育;药物治疗依从性;高血压非药物治疗策略; 为临床相遇做准备;以及加强解决问题和参与。我们将评估6- 在一项单中心、平行组临床试验中，对334名患者进行了为期一个月的MyBP教练干预， HTN控制不佳（2次门诊访视时收缩压150 - 199或舒张压95 - 119 mm Hg）至（1）HBPM 与MyBP教练;或（2）控制，包括HBPM和智能手机与一般健康应用程序 （WebMD）.对于干预和控制，我们向临床医生提供HBPM总结，以改善HTN 对农村病人的管理。我们将遵循治疗强化和调整高血压 在12个月的试验中使用药物;并跟踪（a）6-和12- 月覆盖天数比例和（B）6个月遵守HBPM。我们的目标是：（1）检查效果 6个月时MyBP教练干预对BP的影响，并在12个月时评估其影响的可持续性;（2） 评估干预对BP药物和HBPM依从性的影响;（3）确定 干预对患者报告的结局的影响，包括生活质量、参与度和社会 隔离我们的试验利用了我们的卫生系统的基础设施在农村PA，一个共同的电子健康 我们的大型医疗保健系统的记录，并建立了农村临床合作伙伴关系。我们将方法 我们之前曾申请招募地理位置偏远、健康和数字能力有限的农村个人 扫盲，进行远程评估，并提供类似的基于智能手机的资源和指导。 预期结果：在本项目中，我们将评估一种可扩展的、以患者为中心的干预措施，以改善BP 控制，药物和HBPM依从性，以及患者报告的结果。如果成功，这 可以广泛传播干预措施，以改善对控制不佳的HTN农村患者的护理。

Hypertension (HTN) is the leading modifiable cause of cardiovascular disease. The Surgeon General’s 2020 Call to Action to Control Hypertension articulated the critical relevance of multilevel strategies to address the social determinants and access to care that affect HTN control. Rural individuals experience the additional challenges of the rural health divide: geographic distance from providers, social isolation, limited social resources, and high rates of low health literacy. We have developed and validated a smartphone-based program for home-based blood pressure monitoring (HBPM), termed MyBP, and have demonstrated the success of MyBP to promote adherence to HBPM, improve blood pressure (BP) control, and enhance patient engagement. We now adapt MyBP as a virtual agent, termed MyBP Coach, and leverage our experience with such agents to provide longitudinal health education, empathic guidance, monitoring, and adaptable patient-centered coaching to rural individuals with cardiovascular disease. Here, guided by a patient advisory committee, we provide MyBP Coach to rural individuals as a personalized curriculum to promote and support HBPM; HTN education; medication adherence; non-pharmacologic strategies for HTN management; preparation for the clinical encounter; and enhanced problem-solving and engagement. We will evaluate the 6- month MyBP Coach intervention in a single-center, parallel group clinical trial, randomizing 334 patients with poorly controlled HTN (systolic BP 150-199 or diastolic BP 95-119 mm Hg at 2 ambulatory visits) to (1) HBPM with MyBP Coach; or (2) the control, consisting of HBPM and a smartphone with a general health application (WebMD). For both intervention and control, we provide HBPM summaries to clinicians to improve HTN management for rural patients. We will follow treatment intensification and adjustment of hypertensive medications over the 12-month trial; and track (a) adherence to antihypertensive medication with 6- and 12- month proportion of days covered and (b) 6-month adherence to HBPM. Our aims are: (1) Examine the effect of the MyBP Coach intervention on BP at 6 months and assess the sustainability of its effects at 12 months; (2) Evaluate the effect of the intervention on adherence to BP medications and HBPM; and (3) Determine the effect of the intervention on patient-reported outcomes including quality of life, engagement, and social isolation. Our trial leverages our health system’s infrastructure across rural PA, a common electronic health record of our large health care system, and established rural clinical partnerships. We incorporate methods previously applied by us to recruit geographically isolated rural individuals with limited health and digital literacy, conduct remote assessments, and provide similar smartphone-based resources and instruction. Expected Results: In this project we will evaluate a scalable and patient-centered intervention to improve BP control, medication and HBPM adherence, and patient-reported outcomes. If proven successful, this intervention can be broadly disseminated to improve the care of rural patients with poorly controlled HTN.