TeleHealth & Remote Measurement Technologies to Improve Med Adherence in HTN

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DESCRIPTION (provided by applicant): Broad Challenge Area: 01: Behavior, Behavioral Change, and Prevention. Specific Challenge Topic: 06-OD(OBSSR)-101. Using new technologies to improve or measure adherence. At least half of the U.S.'s hypertension (HTN) patients are non- adherent to their prescribed anti-hypertensive medications which contributes to the appalling statistic that only 34% of Americans treated for HTN have controlled blood pressure (BP). Nonetheless, there is little being done in medical practice settings to improve adherence in HTN. We pioneered the use of telehealth technology in adherence promotion in medical practice settings. Our intervention was efficacious for improving adherence and BP control, but its effect was relatively small (effect size=.27). In this RC1 project, we will explore 2 significant technology-based modifications designed to increase the effect (using electronic measurement technology and electronic health system communication channels) to substantially enhance the effect of our telehealth program. In addition to potentially enhancing our intervention, the results will be transferable to other adherence promotion programs and should advance the science of adherence promotion. We plan to conduct a series of 3 studies in which the results or the first 2 will inform the design of the third. In study 1, we will evaluate alternative methods and protocols for measuring medication adherence and using the results to improve adherence via our telehealth program. In study 2, we will evaluate alternative strategies for delivering information and advice/decision support to physicians via their EHR for them to use during office visits to promote adherence and BP control. In study 3, we will combine the best methods and strategies from studies 1 & 2 and combine them with our original telehealth program. We will evaluate this enhanced program in a RCT with 152 non- adherent hypertension patients. We will determine the effect size of this study and compare it to our original study and other adherence promotion programs to judge its relative efficacy. We will look for expected behavioral mediating effects and effects of known moderators on intervention effects. The potential outcomes of this project are: (1) a more effective intervention, (2) more effective strategies to engage physicians in adherence promotion & medication regimen adjustment, and (3) understanding on how to use 3 technologies to promote adherence. Patients frequently do not take their medications as their physicians prescribe them, and this is a major contributor to suboptimal health outcomes for patients; for example, only one-third of hypertension patients under treatment have their blood pressure adequately controlled. We propose to utilize new technologies - 1) electronic monitoring of patient medication-taking and blood pressures, 2) computer-based telecommunications technologies for facilitating patient/physician communications, and 3) electronic health records systems - to help patients and their physicians deal with this problem. In this proposed project, we will develop a model medication improvement program and apply this program and study it in patients with hypertension, the most common chronic disease.