Efficacy of Web-based Feedback to Improve Blood Pressure Control

描述（由申请人提供）：高血压是美国发病率和死亡率最重要的根本原因之一。尽管存在循证高血压指南，但只有不到三分之一（29%）的高血压患者血压得到控制。虽然高血压患者通常不坚持治疗，但医生的决定在这个问题上起着重要作用。允许患者向医生提出具体问题已被证明在改善预防保健方面广泛有效，但其对血压控制的影响尚未得到研究。我们开发了一个基于网络的程序，供高血压患者在看医生之前使用。该计划询问患者有关他们的药物，高血压护理和血压控制的问题。根据这些反应和基于指南的规则，患者得到个性化的反馈。反馈包括患者应该考虑向其提供者询问的问题，例如“我将收缩压保持在140以下是否有益？“沿着支持信息和到信誉良好的网站的链接（例如，NIH）以进一步阅读该主题。鉴于患者倾向于接受他们向医生要求的测试和治疗，该网站旨在激发患者提出问题，从而更好地控制血压。该研究的主要目的是测试提供网站高血压模块的访问权限的有效性。我们将招募初级保健提供者（26），并将他们随机分为两种情况，干预（1C）和对照（CC）。将从每个提供者招募高血压患者（500名），并允许其访问网站的高血压模块（干预条件）或预防服务模块（控制条件），后者作为主动控制条件。根据JNC 7标准（糖尿病或慢性肾脏疾病患者<130/80，所有其他成人<140/90），主要结局将是每组血压得到控制的患者百分比。我们假设，访问该网站12个月后，1C中60%的患者的血压将得到控制，而CC中的这一比例为40%。不受控制的高血压是对公众健康的最大威胁之一。这项研究旨在测试基于网络的干预措施的效果，通过鼓励患者在医生访问期间提出具体问题，有可能改善血压控制。由于四分之三的美国人现在可以上网，这种干预措施对改善血压控制和通过改善其他常见慢性疾病的护理质量来改善公众健康大有希望。

DESCRIPTION (provided by applicant): Hypertension is one of the most important underlying causes of morbidity and mortality in the US. Despite the existence of evidence-based hypertension guidelines, fewer than one in three patients (29 percent) with hypertension have their blood pressure under control. Though patients with hypertension often do not adhere to treatments, physician decisions have a significant role in this problem. Prompting patients to ask doctors specific questions has proven widely effective in improving preventive care, but its effect on blood pressure control has not been studied. We have developed a web-based program to be used by patients with high blood pressure before doctor visits. The program asks patients questions about their medications, their hypertension care and their blood pressure control. Based on these responses and guideline-based rules, patients are given personalized feedback. The feedback includes questions that the patient should consider asking their provider, such as "Would I benefit from keeping my systolic blood pressure less than 140?" along with supporting information and a link to a reputable website (e.g., NIH) for further reading on the topic. Given that patients tend to get tests and treatments that they ask their physicians for, the website is designed to activate patients to ask questions that lead to better blood pressure control. The main aim of the study is to test the efficacy of providing access to the hypertension module of the website. We will recruit primary care providers (26) and randomize them into two conditions, intervention (1C) and control (CC). Patients with hypertension (500), from each provider, will be recruited and given access to the hypertension module of the website (Intervention Condition) or the preventive services module (Control Condition), which serves as an active control condition. The primary outcome will be the percentage of patients in each group whose blood pressure is controlled, according to JNC7 criteria (<130/80 for patients with diabetes or chronic kidney disease, <140/90 for all other adults). We hypothesize that, after 12 months of access to the website, 60 percent of patients in the 1C will have their blood pressure controlled, compared to 40 percent of patients in the CC. Uncontrolled high blood pressure is one of the greatest threats to the public's health. This study seeks to test the effect of a web-based intervention that, by encouraging patient to ask specific questions during doctor visits, has the potential to improve blood pressure control. As three of four Americans now have access to the Internet, this intervention holds great promise for improving blood pressure control and for improving the public's health by improving the quality of care for other common, chronic illnesses.