Minding Goals: An Internet-Assisted Mind-Body Behavior Program for Blood Pressure Control

 描述（由申请人提供）：有效的高血压治疗方法有充分的记录，但40%的治疗患者不符合联合国家委员会设定的血压目标。科学证据和临床结果之间的这种差距部分反映了患者对生活方式建议的依从性较低（例如，身体活动、体重和饮食），以及药物不依从性。因此，越来越多的注意力集中在需要为患者提供有效的自我管理支持工具。除了找到帮助患者坚持目前处方的高血压护理的方法外，考虑所提供的治疗选择范围也是有用的。基于证据的综述已经确定减压是降低血压的有效工具，但这种方法通常在实践中没有实施。这一遗漏代表了通过增加压力管理自我管理工具来提高高血压护理质量的机会。此外，由于患者已经表现出对正念的明显兴趣，因此将整体身心干预纳入其中是一种创新的方法，可以实现以患者为中心的护理。越来越多的数据支持使用正念来治疗健康问题。它的整体性可能特别适合于发展和保持健康的生活方式，因为生活方式影响身心健康的各个方面。然而，正念在健康自我管理中的潜力尚未实现。有限但有希望的数据证明了基于网络的行为矫正咨询对改善常见慢性病风险因素的有效性。这是一个理想的解决方案，以提供时间限制和潜在的解决方案，以病人不遵守生活方式的建议。保健信息技术提供了一种使自我管理支助负担得起、方便和可行的途径。我们为基层护理患者开发了一个方便的行为自我管理支持平台，即“目标导向的生活方式支持在线访问”（GOALS），该平台促进了具有体重相关心血管风险因素的基层护理患者的减肥和改善血压控制。为了最大限度地提高患者实现血压目标的能力，我们建议在目标中添加一个在线身心行为计划：“Minding GOALS。“我们将评估在76名高血压不受控制的患者中，与初级保健协调使用该计划进行自我管理支持的可行性。在准备将在线工具与在线传统自我管理支持进行比较的RCT时，我们将评估实施情况并确定1）使用拟议招募方法的合格和自愿受试者的可用性，2）在感兴趣人群中提供拟议干预措施的可行性，以及3）我们拟议测量方案的可行性。我们将根据需要修改研究方案，识别和纠正问题，以加强未来RCT的设计，并帮助确保其对以患者为中心的高血压自我管理支持的进步做出有意义的贡献。

 DESCRIPTION (provided by applicant): Efficacious hypertension therapies are well-documented, yet 40% of treated patients do not meet the blood pressure goals set by the Joint National Committee. This gap between scientific evidence and clinical outcomes in part reflects low patient adherence to lifestyle recommendations (e.g., physical activity, weight and diet), as well as medication non-adherence. Accordingly, growing attention is focused on the need to provide patients with effective self-management support tools. In addition to finding ways to help patients adhere to currently prescribed hypertension care, it is useful to consider the range of treatment options that are offered. Evidence- based reviews have identified stress reduction as an effective tool for reducing blood pressure, yet such approaches are typically not implemented in practice. This omission represents a chance to improve the quality of hypertension care by adding stress management self-management tools. Furthermore, since patients have demonstrated a clear interest in mindfulness, the incorporation of a holistic mind-body intervention is an innovative approach to inherently patient-centered care. Increasing data supports the use of mindfulness for treating health concerns. Its holistic nature may be particularly well-suited to developing and maintaining healthy lifestyles, since lifestyle impacts diverse aspects of physical and psychological health. Yet the potential for mindfulness in health self-management has not been realized. Limited but promising data demonstrate the effectiveness of web-based counseling for behavior modification to improve common chronic disease risk factors. It is an ideal solution to provider time constraints and a potential solutionto patient non-adherence to lifestyle recommendations. Health information technology provides a way to make self-management support affordable, convenient and feasible. We have developed a convenient behavioral self-management support platform, "Goal-oriented Online Access to Lifestyle Support" (GOALS) for primary care patients, which has promoted weight loss and improved blood pressure control among primary care patients with weight-related cardiovascular risk factors. To maximize the ability of patients to achieve blood pressure goals, we propose to add an online mind-body-behavior program to GOALS: "Minding GOALS." We will evaluate the feasibility of using this program for self-management support in coordination with primary care, in a group of 76 patients with uncontrolled hypertension. In preparation for an RCT comparing the online tool to online traditional self-management support, we will assess implementation and determine 1) the availability of eligible and willing subjects using the proposed recruitment methods, 2) the feasibility of delivering the proposed interventions in the population of interest, and 3) the viability of our proposed measurement protocols. We will modify study protocols as needed, identifying and correcting problems, to strengthen the design of the future RCT and help ensure that it contributes meaningfully to the advancement of patient-centered hypertension self-management support.