Long-Term Outcomes and Costs of Web-Based Hypertension Care (e-BPLT)

高血压（HTN）是美国最常见的慢性疾病，影响近三分之一的成年人；然而，在大多数情况下，它仍然没有得到充分的治疗。以诊所为基础的卫生服务干预措施在降低血压和改善HTN控制方面取得了成功。然而，关于这些影响的持久性，科学文献和政策经验存在差距。了解成功干预的长期影响对HTN治疗尤其重要，因为通过持续降低血压，可以获得最大的健康益处——通过降低死亡率、心血管事件和肾衰竭来衡量。基于一项随机试验的结果，我们建议研究基于网络的通信干预改善血压控制的长期有效性，e-BP：电子通信和家庭血压监测研究（R01 CA075263-01A1， B. Green， PI）。在这项3组研究中，未控制的HTN患者被随机分配到常规治疗组，或接受家庭血压监测仪和使用现有的综合患者门户网站的培训，或通过网络提供药房护理。12个月后，与常规治疗相比，接受基于网络的药剂师帮助的患者控制血压的可能性几乎是常规治疗的2倍。超过92%的随机患者在最后一次随访评估后超过12个月仍在组健康组登记。考虑到团体健康计划参与者退出的历史模式，我们预计超过75%的试验参与者将在研究结束后的5年内继续参加健康计划，这使我们能够评估干预措施对血压和成本的长期影响。因此，我们提出以下目标：目的1：评估干预结束后治疗结果、收缩压、舒张压和血压控制的持久性。目的2：评估以下方面的长期变化：(1)抗高血压药物处方的数量和依从性；（二）使用保密信息；(3)长期使用家庭血压监测仪。目的3a：分析随机化后参与e-BP试验至少5年的患者的医疗服务利用和成本的长期变化。目的3b：利用长期HTN控制的分析结果估计药房干预的长期增量成本效益。目的3a：分析长期医疗成本的变化。

DESCRIPTION (provided by applicant): Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is the most common chronic condition in the U.S., affecting almost 1 in 3 adults; however, it remains inadequately treated in most. Clinic-based health services interventions have achieved success in reducing BP and improving HTN control. There is however, a gap in the scientific literature and policy experience regarding the durability of these effects. Understanding the long-term impact of a successful intervention is of particular importance for HTN treatment where the greatest health benefits-as measured by decreased mortality, cardiovascular events, and renal failure are achieved by persistent reductions in BP. We propose to study the long-term effectiveness of a Web-based communication intervention to improve BP control based on the results of a randomized trial, e-BP: Electronic Communications and Home Blood Pressure Monitoring Study (R01 CA075263-01A1, B. Green, PI). In the 3-arm study patients with uncontrolled HTN were randomized to usual care or to receive home BP monitors and training to use an existing integrated patient Web portal, or this plus pharmacy care delivered over the Web. After 12 months, patients receiving Web- based pharmacist assistance were almost 2 times as likely to have controlled BP compared to usual care. Over 92% of the patients' randomized are still enrolled within Group Health more than 12 months after the last follow-up assessment. Given historical patterns of disenrollment among Group Health enrollees we anticipate over 75% of trial participants will remain with the health plan for a total of 5 years after the study's end, allowing us to assess the long-term effects of the interventions on BP and costs. Thus we propose the following aims: Aim #1: To evaluate the durability of treatment outcomes, systolic BP, diastolic BP, and BP control over time after the intervention ended. Aim #2: To evaluate long-term changes in: (1) the number of and adherence to anti-hypertensive medications prescribed; (2) use of secure messaging; and (3) use of home BP monitors over time. Aim #3a: To analyze long-term changes in health services utilization and cost among patients participating in the e-BP trial for at least 5 years following randomization Aim #3b: To estimate the long-term incremental cost effectiveness of the pharmacy intervention using results from the analysis of long-term HTN control-Aim 1, and changes in long-term health care costs-Aim 3a. PUBLIC HEALTH RELEVANCE: Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is a common chronic condition in the United States, affecting almost 1 in 3 adults; however, it remains inadequately treated in most. A recent research study showed that HTN control could be improved by providing patients with home blood pressure monitors, Web-based resources to communicate with their health care team, and pharmacist assistance with medications. However it is unknown whether HTN control persisted and health care costs decreased after the study ended. We will study the long-term effects of a Web-based HTN intervention on blood pressure and health care costs.