Electronic Communications and Home Blood Pressure Monitoring
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 25 - 75 |
| Updated: | 10/15/2017 |
| Start Date: | June 2005 |
| End Date: | December 2007 |
The control of blood pressure (BP) for patients with hypertension on medications has been
elusive, despite the availability of evidence-based nationally recognized guidelines for
treatment and 30 years of research addressing this. At present, less than 50% of patients
with known hypertension are adequately controlled. If BP control could be improved,
significant decreases in cardiovascular morbidity and mortality would occur.
The purpose of this study is to conduct a randomized controlled trial of the effectiveness of
the provision of home blood pressure measurement and electronic communications (secure
messaging to health care providers) to improve hypertension control.
elusive, despite the availability of evidence-based nationally recognized guidelines for
treatment and 30 years of research addressing this. At present, less than 50% of patients
with known hypertension are adequately controlled. If BP control could be improved,
significant decreases in cardiovascular morbidity and mortality would occur.
The purpose of this study is to conduct a randomized controlled trial of the effectiveness of
the provision of home blood pressure measurement and electronic communications (secure
messaging to health care providers) to improve hypertension control.
This is single-blind, randomized, controlled trial, to test the effectiveness of applying the
chronic care model to hypertension.
There is an emerging consensus that multifaceted, multilevel, interventions are most
effective in improving care for chronic conditions. In order to successfully plan and execute
the required strategies, care planning is being increasingly conducted by the use of systems
planning models. Since its original description by Wagner, Austin and Von Korff in 1996, the
Chronic Care Model has found wide application, acceptance and success in planning care for
chronic diseases, however to our knowledge, it has not yet been applied to the care of
hypertension. There are six components of the model, including: clinical information systems,
decision support, delivery system design, self-management support, organizational support,
and community resources. The model describes these components to activate both patients and
physicians, and when this occurs optimally, health outcomes improve. The interventions below
are designed according to this construct and to determine whether enhanced patient
self-management support in the form of home blood pressure monitoring and augmented delivery
system design with pharmaceutical care improves hypertension control.
- Group-1 (Usual Care) will receive usual care for their hypertension. This includes the
following for physicians: guidelines and decision support for treatment of hypertension,
reminds and feedback as to medication choices, the use of electronic medical records
with the ability to graphically display blood pressures over time. Patients have access
to secure Intranet services already available at GHC including portions of their
electronic medical record (including their blood pressures and the graphic display of
these), messaging, and prescription refill services, and laboratory results.
- Group-2 (Blood Pressure Monitoring) will additionally receive home blood pressure
monitors, instruction on their use, and a proficiency training session on Web-based
communication and encouraged to use this to communicate their blood pressures with their
physician, refill medications, and view parts of their medical records (blood pressures,
labs, medication list).
- Group-3 (Blood Pressure Monitoring and Pharmaceutical Care) will receive all of the
above plus planned and proactive, self and care management support provided by clinical
pharmacists via the Web. One of three clinical pharmacists will be assigned to each
patient in group 3. The clinical pharmacist will initially telephone the patient and do
an intake visit to assess their medical history specific to hypertension care and assist
the patient in designing an action plan that addresses blood pressure self-monitoring,
medication use, lifestyle habits to reduce blood pressure and cardiovascular risk (they
will assist the patient in choosing one lifestyle activity to work on), and follow-up
plans. The pharmacist and patient will communicate at regular intervals by secure
message (telephone and clinic visits will be occur if needed) and work collaboratively
to improve blood pressure control. The pharmacist will use a medication algorithm (based
on Group Health and JNC7 guidelines) to adjust medications until goal blood pressure is
reached (<135 mmHg and <85 mmHg average for home BP measurements) and will provide
information as to resources available within Group Health or the community to assist
patients with their lifestyle goals. Record keeping will occur in the electronic medical
record with key aspects shared electronically and securely with the patient and their
physician.
The interventions will be delivered over a period of 12-months.
chronic care model to hypertension.
There is an emerging consensus that multifaceted, multilevel, interventions are most
effective in improving care for chronic conditions. In order to successfully plan and execute
the required strategies, care planning is being increasingly conducted by the use of systems
planning models. Since its original description by Wagner, Austin and Von Korff in 1996, the
Chronic Care Model has found wide application, acceptance and success in planning care for
chronic diseases, however to our knowledge, it has not yet been applied to the care of
hypertension. There are six components of the model, including: clinical information systems,
decision support, delivery system design, self-management support, organizational support,
and community resources. The model describes these components to activate both patients and
physicians, and when this occurs optimally, health outcomes improve. The interventions below
are designed according to this construct and to determine whether enhanced patient
self-management support in the form of home blood pressure monitoring and augmented delivery
system design with pharmaceutical care improves hypertension control.
- Group-1 (Usual Care) will receive usual care for their hypertension. This includes the
following for physicians: guidelines and decision support for treatment of hypertension,
reminds and feedback as to medication choices, the use of electronic medical records
with the ability to graphically display blood pressures over time. Patients have access
to secure Intranet services already available at GHC including portions of their
electronic medical record (including their blood pressures and the graphic display of
these), messaging, and prescription refill services, and laboratory results.
- Group-2 (Blood Pressure Monitoring) will additionally receive home blood pressure
monitors, instruction on their use, and a proficiency training session on Web-based
communication and encouraged to use this to communicate their blood pressures with their
physician, refill medications, and view parts of their medical records (blood pressures,
labs, medication list).
- Group-3 (Blood Pressure Monitoring and Pharmaceutical Care) will receive all of the
above plus planned and proactive, self and care management support provided by clinical
pharmacists via the Web. One of three clinical pharmacists will be assigned to each
patient in group 3. The clinical pharmacist will initially telephone the patient and do
an intake visit to assess their medical history specific to hypertension care and assist
the patient in designing an action plan that addresses blood pressure self-monitoring,
medication use, lifestyle habits to reduce blood pressure and cardiovascular risk (they
will assist the patient in choosing one lifestyle activity to work on), and follow-up
plans. The pharmacist and patient will communicate at regular intervals by secure
message (telephone and clinic visits will be occur if needed) and work collaboratively
to improve blood pressure control. The pharmacist will use a medication algorithm (based
on Group Health and JNC7 guidelines) to adjust medications until goal blood pressure is
reached (<135 mmHg and <85 mmHg average for home BP measurements) and will provide
information as to resources available within Group Health or the community to assist
patients with their lifestyle goals. Record keeping will occur in the electronic medical
record with key aspects shared electronically and securely with the patient and their
physician.
The interventions will be delivered over a period of 12-months.
Inclusion Criteria:
- Diagnosis of hypertension in the prior two years and on hypertension medications
- Access to the Internet and an e-mail address
- Ability to use a computer using the English language
- Medical care coverage which permits them to refill prescriptions at Group Health
Cooperative pharmacies and a willingness to do so.
- Blood pressure on each of two screening visits averaging > 90 mmHg diastolic or > 140
mmHg systolic and < 110 mmHg diastolic or < 200 mmHg systolic
Exclusion Criteria:
- Diagnosed or history of diabetes, cardiovascular disease (ischemic heart disease,
valvular heart disease, heart failure, arrhythmias, strokes or transient ischemic
attacks, and peripheral vascular disease)
- Current treatment for cancer, on immunosuppressant or antiretroviral treatment.
- Surgery or hospitalization in the prior 3 months
- Pregnancy (or plans to become pregnant in the next 12 months)
- Plans to move out of the area or leave the health plan in the next 12 months.
- Upper arm circumference size > 18 inches.
- Arrhythmia detected at screening visits
We found this trial at
1
site
Click here to add this to my saved trials
