Please select the eligibility criteria that correspond to the clinical trial below.
Title: Using a Telemedicine System to Promote Patient Care Among Underserved Individuals
Brief Summary: We have established a Telemedicine System for chronic disease management. Based on a personal health record, we have successfully used this system in diverse populations, in over 600 patients, and in multiple disease states (heart failure, CVD risk reduction, gestational diabetes). In this proposal, we will enhance this Telemedicine system to support patient centered care (PCC) by increasing access, incorporating hypertension treatment guideline, quality measures, automating reminders and feedback for both patients and health care providers.

Inner-city, primarily African-American patients (N=252) with uncontrolled hypertension (BP\<140/90 mmHg) and who are followed by primary care physicians will be randomized to either a usual care or a telemedicine group (Telemedicine plus usual care). Blood pressure, weight, BMI, blood glucose and lipids, and physical activity will be measured at baseline and at 6 months. We hypothesize that more subjects in the telemedicine group will achieve goal blood pressure than in the control group. This will occur through increases in knowledge, self-management, shared decision-making, and improved doctor-patient interaction. Primary end- point will be the proportion of subjects who achieve goal blood pressure. Secondary end-points will include:

Rate of self-monitoring, steps per day, weight, CVD knowledge, number of patients at medication guidelines, and increased satisfaction with practice. Telemedicine utilization will also be determined. We believe that telemedicine can facilitate PCC and reduce blood pressure in a cost effective manner.


Options:
A: Inclusion Criteria:

* uncontrolled hypertension
* systolic blood pressure \> 140
* access to a telephone or internet

Exclusion Criteria:

* angina
* cognitive defects, dementia
* end stage renal disease
* living in nursing or boarding homes
* pregnant
* unable to sign informed consent
* unable to use a scale, sphygmomanometer, pedometer
B: Inclusion Criteria:

* Patients with type 2 diabetes from participating practices across NHS Leicester, Warwickshire and Coventry.

Exclusion Criteria:

* Patients unable to give informed consent,
* Terminal cancer, OR
* Pregnant.
C: Inclusion Criteria: diagnosis of type 2 diabetes, age 21 years and above, resident of American Samoa receiving primary care at Tafuna Family Health Center -

Exclusion Criteria: pregnancy, receiving kidney dialysis

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D: Inclusion Criteria:

* Adults (≥18 years of age) at high risk for cardiovascular events, including:

  * Patients with diabetes
  * Patients with chronic kidney disease \[eGFR \<60 ml/min/1.73m2 and/or (ACR \>= 30 mg/mmol or two consecutive ACR tests which are \>= 3 mg/mmol)\]
  * Patients with established atherosclerotic vascular disease including cerebrovascular disease (prior stroke or transient ischemic attack), cardiovascular disease (myocardial infarction, acute coronary syndrome, stable angina, or revascularization), or peripheral arterial disease (symptomatic and/or ankle brachial index \<0.9).
  * Primary prevention patients with multiple risk factors and Framingham risk score \>20%
  * In order to qualify for inclusion, all patients must have at least one uncontrolled risk factor (i.e., blood pressure, LDL-cholesterol, HbA1c, or current smoking)

Exclusion Criteria:

* Unwilling to participate/sign consent form
* Unwilling or unable to participate in regular follow-up visits
* Pregnancy

Answer: A