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

描述（由申请人提供）：基于网络的高血压护理的长期结局和成本高血压（HTN）是美国最常见的慢性疾病，几乎每三个成年人中就有一个受到影响;然而，在大多数人中，这种疾病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，在这些影响的持久性方面，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HTN治疗的最大健康益处（通过降低死亡率、心血管事件和肾衰竭来衡量）是通过持续降低血压来实现的。我们建议研究基于网络的沟通干预改善血压控制的长期有效性，这是基于一项随机试验的结果，e-BP：电子沟通和家庭血压监测研究（R 01 CA 075263 - 01 A1，B.绿色，PI）。在3组研究中，不受控制的HTN患者随机接受常规治疗或接受家庭血压监测和培训，以使用现有的综合患者Web门户网站，或通过Web提供药房护理。12个月后，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护理的2倍。超过92%的随机化患者在末次随访评估后12个月仍入组Group Health。考虑到团体健康参与者的历史退选模式，我们预计超过75%的试验参与者将在研究结束后继续参加健康计划共5年，使我们能够评估干预措施对BP和成本的长期影响。因此，我们提出了以下目标：目标#1：评估干预结束后治疗结局、收缩压、舒张压和血压控制随时间的持续性。目标二：评价以下方面的长期变化：（1）处方抗高血压药物的数量和依从性;（2）安全消息的使用;（3）家用血压监测仪的使用。目标3a：分析随机化后至少5年内参加e-BP试验的患者的卫生服务利用和成本的长期变化目的3b：使用长期HTN对照分析结果（目的1）和长期卫生保健成本变化（目的3a）估计药房干预的长期增量成本效果。 公共卫生相关性：基于网络的高血压护理的长期结果和成本高血压（HTN）在美国是一种常见的慢性疾病，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。最近的一项研究表明，HTN控制可以通过为患者提供家庭血压监测仪，基于网络的资源与他们的医疗保健团队进行沟通，以及药剂师协助药物治疗来改善。然而，尚不清楚研究结束后HTN控制是否持续以及医疗保健费用是否下降。我们将研究基于网络的HTN干预对血压和医疗保健费用的长期影响。

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.