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公认的治疗指南和30年来解决这一问题的研究，但药物治疗高血压患者的血压(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了充分的控制。如果血压控制得到改善，心血管发病率和死亡率将显著下降。我们建议对应用慢性护理模式(CCM)改善高血压控制的有效性进行随机对照试验。我们将确定一组服用降压药、可以使用互联网和电子邮件、血压控制不佳的团体健康合作患者(BP&GT；140/90)。愿意参与的受试者将被随机分配到三个干预组中的一个：第一组(UC)将接受常规的高血压治疗。这包括访问GHC已经提供的安全内部网服务(包括健康图书馆、报文传送和处方配药服务)；第二组(BPM)将另外获得家用血压监测仪、使用说明和基于网络的沟通熟练培训课程；或第三组(BPM+RX)，他们将获得所有上述服务以及由临床药剂师通过网络提供的计划和积极主动的自我护理管理支持。我们的研究假设是，BPM+Rx将被证明在改善以下主要结果方面比UC或BPM更有效：(1)平均舒张压、收缩压以及舒张压和收缩压综合平均值的变化，以及(2)血压得到充分控制的患者比例(定义为血压等于或等于&lt；140 mm Hg，等于或&lt；90 mm Hg舒张压)。

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).