Hypertension Telemanagement in African Americans

描述(由申请人提供)： 使用电信技术的研究已经成功地影响了慢性病护理的主要组成部分，包括医生的执业模式、患者对治疗的依从性以及患者与提供者的沟通。到目前为止，还没有研究评估在与初级保健做法相联系的综合框架中同时采用所有这些组成部分的协调办法。在这项研究中，我们建议评估一个多组件远程管理系统，为临床医生和患者提供综合支持，遵循JNC7报告颁布的高血压治疗指南。以互联网为基础的家庭自动化远程管理(HAT)系统实施了一个多组件的慢性病管理模式，其中包括定期患者评估、针对疾病的教育、控制患者遵守治疗计划、促进治疗生活方式的改变、全面的患者与提供者的沟通和计算机化的决策支持。在这项提案中，我们将(1)完善HAT系统，以全面实施非裔美国人高血压远程管理的多学科模型(2)在随机对照试验中评估HAT对非裔美国人高血压控制率的临床影响的程度，并检查拟议方法的成本效益。患者将在家里安装HAT装置(连接到血压计和体重秤的联网计算机)，并将指导如何使用它。他们将被要求定期进行自我测试，并在电脑屏幕上回答问题(症状、用药情况和其他自我护理行为)。每个HAT会议将包括(1)患者评估(客观测量，如血压和体重，自动下载到计算机，以及患者报告的参数，如患者的症状和用药情况)，(2)根据患者的医生生成的个性化治疗计划进行解释和建议，(3)结构化高血压教育，(4)患者咨询和健康行为调整(基于社会认知理论的主要结构，如行为能力、自我效能、结果预期和强化)，(5)社会支持(虚拟患者小组，与社会工作者沟通)，总体而言，550名患有高血压的非裔美国人将从50家初级保健诊所登记，并将接受为期18个月的跟踪调查。主要研究结果将是达到JNC7建议的血压目标的接受治疗的患者的比例，以及收缩压和舒张压的平均变化。我们还将探讨HAT对医生意识和遵守JNC7指南的影响，以及患者实现JNC7报告建议的生活方式改变目标的能力。最后，对非裔美国人高血压患者进行HAT干预的成本-效果分析。

DESCRIPTION (provided by applicant): Studies employing telecommunication technologies have been successful in affecting the major components of chronic disease care including physician practice patterns, patient adherence to therapy, and patient-provider communication. To date there have been no studies evaluating a coordinated approach that simultaneously employs all of these components in an integrated framework linked to primary care practices. In this study we propose to evaluate a multicomponent telemanagement system providing an integrated support both to clinicians and patients in following hypertension treatment guidelines promulgated by JNC 7 Report. The Internet-based Home Automated Telemanagement (HAT) system implements a multi-component chronic disease management model which includes regular patient assessment, disease-specific education, control of patient adherence to treatment plans, promotion of therapeutic lifestyle changes, comprehensive patient-provider communication and computerized decision support. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of hypertension in African Americans (2) evaluate in a randomized controlled trial the magnitude of clinical impact of HAT on hypertension control rates in African Americans and examine cost-effectiveness of the proposed approach. Patients will have the HAT units (Internet-enabled computer connected to a blood pressure monitor and weight scale) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as blood pressure and body weight, which are automatically downloaded to the computer, and patient-reported parameters such as patient symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured hypertension education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker),. Overall, 550 African Americans with hypertension will be enrolled from 50 primary care clinics and will be followed for 18 months. The main study outcomes will be proportion of treated patients that achieve blood pressure goals meeting JNC 7 recommendations, and mean change in systolic and diastolic pressure. We will also explore HAT impact on physician awareness and adherence to JNC 7 guidelines, and patient ability to reach lifestyle modification goals recommended by the JNC 7 Report. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the African American patients with hypertension.