Collaborative Behavioral e-Care to Decrease Cardiovascular Risk (e-Compare)

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DESCRIPTION (provided by applicant): Overweight and obese adults are more likely to have hypertension and other risk factors for cardiovascular disease (CVD). Evidence-based medication and lifestyle strategies can be used to decrease CVD risk, but little is known about the comparative effectiveness and cost-effectiveness of these strategies and how best to integrate them into routine health care. We have previously demonstrated that Web-based pharmacist medication management intervention can cost-effectively improve HTN control (e-BP: Electronic Communication and Home Blood Pressure Monitoring; R01 HL075263, B. Green, PI). Web-based pharmacy care did not lead to lifestyle behavior change or weight loss. However patients who lost small amounts of weight (2 kg or more) were more likely to have controlled BP (p=.008), regardless of their study group assignment. We propose to use Health Information Technology systems (HIT) to identify asymptomatic patients at moderate risk for CVD and invite them to participate in a theory-based behavioral intervention. Aim #1: We hypothesize that using electronic databases alone, we can identify asymptomatic overweight or obese patients, with uncontrolled BP, and at moderate risk for CVD who might benefit from a behavioral intervention. To test this hypothesis we will measure: Primary outcomes: " The proportion of asymptomatic patients with data for BMI, BP, lipids, and tobacco use " The proportion at moderate risk for CVD (using Framingham risk scores) and the independent effect of obesity on Framingham risk scores. Secondary outcome: " The marginal costs related to moderate risk for CVD with and without obesity. Aim #2: We hypothesize that a dietitian-delivered behavioral intervention, that uses a patient shared EMR and e-communications, can be integrated into routine healthcare and will result in improved control of modifiable CVD risk. To test this hypothesis we will measure: Primary outcomes: " The proportion of patients who agree to participate and complete the intervention " The change in mean systolic and diastolic BP and weight (kg), and a weight loss of 4 kg or more, and the change in Framingham risk score. Secondary outcomes: " Patient satisfaction with the intervention, its effects on health related quality of life (HrQOL) and the cost of delivering the intervention. Adults with high blood pressure (BP) and obesity are at higher risk for heart disease and strokes. A recent study (e-BP) showed that patients who monitored their BP at home and received pharmacist care over the Web had improved BP control. We will be studying whether similar care delivered by dietitians over the Web leads to improved BP control and weight loss.