Electronic Communications and Home B.P. Monitoring

描述（由申请人提供）：尽管有基于证据的国家认可的治疗指南和30年的研究解决了这一问题，但高血压患者的药物血压（BP）控制一直难以捉摸。目前，只有不到50%的已知高血压患者得到充分控制。如果血压控制得到改善，心血管疾病的发病率和死亡率将显著降低。我们建议进行一项随机对照试验，探讨应用慢性护理模式（CCM）改善高血压控制的有效性。我们将确定一组接受降压药物治疗的高血压患者，他们可以使用互联网和电子邮件，血压控制不佳（BP > 140/90）。愿意参加的受试者将被随机分配到三个干预组之一：第1组（UC）将接受常规高血压治疗。这包括使用全球人道主义中心已有的安全内联网服务（包括健康图书馆，信息和处方续药服务）;第2组（BPM），将额外获得家庭血压监测仪，使用说明和基于网络的通信熟练培训课程;或第3组（BPM+RX），他们将获得上述所有内容，以及临床药剂师通过网络提供的计划性和主动性自我和护理管理支持。我们的研究假设是，BPM+Rx将证明在改善以下主要结局方面比UC或BPM更有效：（1）平均舒张压、收缩压以及舒张压和收缩压的合并平均值的变化和（2）血压控制充分的患者比例（定义为收缩压等于或<140 mmHg且舒张压等于或<90 mmHg）。

DESCRIPTION (provided by applicant): The control of blood pressure (BP) for patients with hypertension on medications has been elusive, despite the availability of evidence-based nationally recognized guidelines for treatment and 30 years of research addressing this. At present less than 50% of patients with known hypertension are adequately controlled. If BP control could be improved, significant decreases in cardiovascular morbidity and mortality would occur. We propose to conduct a randomized controlled trial of the effectiveness of applying the Chronic Care Model (CCM) to improve hypertension control. We will identify a cohort of Group Health Cooperative patients with hypertension on anti-hypertensive medications, who have access to the Internet and E-mail, and who have poorly controlled blood pressure (BP > 140/90). Subjects willing to participate will be randomly assigned to one of three intervention arms: Group-1 (UC) will receive usual care for their hypertension. This includes access to secure Intranet services already available at GHC (including a health library, messaging, and prescription refill services); Group-2 (BPM), will additionally receive home blood pressure monitors, instruction on their use, and a proficiency training session on Web-based communication; or Group-3 (BPM+RX), who will receive all of the above plus planned and proactive, self and care management support provided by clinical pharmacists via the Web. Our study hypothesis is that BPM+Rx will prove to be more efficacious than UC or BPM in improving the following primary outcomes: (1) change in mean diastolic, systolic, and the combined average of diastolic and systolic blood pressure and (2) proportion of patients with adequately controlled blood pressure (defined as a BP of equal to or <140 mmHg systolic and equal to or <90 mmHg diastolic).