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很好的证明，但40%的接受治疗的患者没有达到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在一定程度上反映了患者对生活方式建议(例如，体力活动、体重和饮食)的低依从性，以及药物治疗的不遵守。因此，越来越多的人关注为患者提供有效的自我管理支持工具的必要性。除了找到帮助患者坚持目前处方的高血压治疗的方法外，考虑所提供的治疗选择的范围也是有用的。循证审查发现，减压是降低血压的有效工具，但这种方法通常没有在实践中实施。这一遗漏意味着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，由于患者对正念表现出明显的兴趣，纳入整体心身干预是一种以患者为中心的内在护理的创新方法。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维持健康的生活方式，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表明，基于网络的咨询对改善常见慢性病风险因素的行为纠正是有效的。它是解决提供者时间限制的理想解决方案，也是解决患者不遵守生活方式建议的潜在解决方案。卫生信息技术提供了一种使自我管理支持负担得起、方便和可行的方法。我们为初级保健患者开发了一个便捷的行为自我管理支持平台--《面向目标的在线获取生活方式支持》(Goals)，促进了有体重相关心血管危险因素的初级保健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，我们建议在目标中增加一个在线精神-身体-行为计划：“注意目标”。我们将评估在76名未控制的高血压患者中使用该计划进行自我管理支持并配合初级保健的可行性。在准备将在线工具与在线传统自我管理支持相比较的随机对照研究中，我们将评估实施情况，并确定1)使用建议的招募方法获得合格和有意愿的受试者，2)在感兴趣的人群中提供建议的干预措施的可行性，以及3)我们建议的衡量协议的可行性。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，并帮助确保它对促进以患者为中心的高血压自我管理支持做出有意义的贡献。

 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.