Electronic Communications and Home Blood Pressure Monitoring
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional
Phase: Phase 3

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Home BP;secure messaging;pharmaceutical care;
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Blood Pressure Monitoring, home; Pharmaceutical services; Self care