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:

* 18 years of age or older
* Symptoms consistent with acute stroke (ischemic or hemorrhagic)
* Acute presentation of stroke symptoms, per bedside physician discretion (onset generally less than 12 hours and likely less than 3 hours)

Exclusion Criteria:

* Unlikely to complete study through 90-day follow-up
B: 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
C: Inclusion Criteria:

* Patient has been previously implanted with a dual-chamber or single-chamber EnPulse®, Kappa 900®, or Adapta® device
* Patient agrees to complete all required follow-up transmissions and in-office visits
* Patient is capable of operating the TTM monitor and Medtronic CareLink monitor

Exclusion Criteria:

* Patient is an immediate candidate for an implantable cardioverter defibrillator (ICD)
D: Inclusion Criteria:

* Patients with BMI \>25 will be recruited from the primary care clinics at Hines Hospital VAMC. Enrollment of patients with this BMI criteria allows comparability with other obesity behavioral treatment trials. The enrollment policy is also consistent with the 2005 VA/DoD Practice Guideline that recommends obesity treatment for all Veterans with BMI \>25.
* Male or female Veterans
* Age \>18
* With chronic pain (Numeric Rating Scale of pain intensity \[NRS-I\] \> 4 for \> 6 months prior to enrollment)
* Ready to make a weight loss effort involving diet and activity change
* Able to communicate comfortably in English.
* The primary pain complaint must be possibly related to obesity (e.g., back, knee, leg, neck, arm, or full-body pain, and not exclusively headache or cancer-related pain).

Exclusion Criteria:

* Has an active eating disorder or substance abuse disorder --Participating in another VA-funded research project -Significant cognitive or sensorimotor impairment precluding use of the PDA
* Already participating in a structured diet or exercise program or plans to begin such a program outside the study during the next year; requires use of an assistive device for mobility
* At risk for adverse cardiovascular events with moderate intensity activity
* Plans to relocate within the upcoming year

Answer: B