Remote Monitoring and Virtual Collaborative Care For Hypertension Control To Prevent Cognitive Decline

Study Overview
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Brief Summary
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This purpose of this study is to examine an aggressive method of blood pressure control that involves home blood pressure monitoring and management of medications by a team of clinical pharmacists in coordination with a primary care physician.

Official Title
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Remote Monitoring and Virtual Collaborative Care For Hypertension Control To Prevent Cognitive Decline: Phase I

Conditions
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Cognitive Decline, Hypertension

Intervention / Treatment
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* Other: Virtual Collaborative Care Clinic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 65 and older Active patient in participating primary care clinic Access to compatible smartphone or device (i.e., Android, Kindle or Apple with internet connectivity) Elevated blood pressure as defined by: Systolic Blood Pressure >140 at current visit AND documented history of hypertension OR Systolic Blood Pressure > 140 at current visit and at another visit in last 18 months OR Systolic Blood Pressure >160 at current visit Sufficiently fluent in English to participate in study procedures Adequate vision and hearing to complete study procedures Exclusion Criteria: Clinically significant illness that may affect safety or completion per their treating Primary Care Physician or study physician End stage renal disease on dialysis Chronic active disease with expected life expectancy < 2 years as determined by the study team

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual Collaborative Care Clinic<br>The Virtual Collaborative Care Clinic arm participants use a home blood pressure monitor and routine blood pressure measurements will be uploaded to a dashboard monitored by clinical pharmacists. Blood pressure will be managed aggressively by the clinical pharmacists in coordination with Primary Care Physicians. | Other: Virtual Collaborative Care Clinic<br>* The vCCC will operate under a collaborative care agreement with the Primary Care Physicians as an extension (and not a replacement) of their care. Trained clinical pharmacists will monitor blood pressure and prescribe and adjust medications under the license of, and in communication with, the patient's Primary Care Physician. As part of the Primary Care Physician's team and per Primary Care Physician's directions, the pharmacists may coordinate blood pressure management with other clinicians such as cardiologists or nephrologists co-managing patients blood pressure.<br>|
| No Intervention: Control Intervention<br>The control intervention will consist of providing the participant with educational material and a home blood pressure monitor. The patients in the control group will not have support from Virtual Collaborative Care Clinic pharmacists. Routine blood pressure measures using their device will not be collected via the dashboard and will not be available for pharmacist review. Participants will continue to see their physicians for their usual care for blood pressure management. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of system wide adoptability as assessed by survey responses | Primary Care Physicians and vCCC Pharmacists will be asked for feedback on feasibility of implementation via a survey. The vCCC pharmacists and PCPs will be surveyed to assess feasibility and changing views of feasibility. Brief, validated scales will be delivered via email (REDCap surveys) to assess the construct of feasibility. | Baseline | 
| Feasibility of system wide adoptability as assessed by survey responses | Primary Care Physicians and vCCC Pharmacists will be asked for feedback on feasibility of implementation via a survey. The vCCC pharmacists and PCPs will be surveyed to assess feasibility and changing views of feasibility. Brief, validated scales will be delivered via email (REDCap surveys) to assess the construct of feasibility. | 3 Months Post Baseline | 
| Feasibility of system wide adoptability as assessed by Physician Advisory Board meetings discussion | Members of the Physician Advisory Board will be asked for feedback on system wide adoptability during the monthly Physician Advisory Board meetings. The meetings will be recorded and summarized. | Through study completion, an average of 9 months | 
| Feasibility of system wide adoptability as assessed by vCCC Pharmacist Interviews | Virtual Collaborative Care Clinic Pharmacists will be asked for feedback on feasibility of system wide adoption. We will conduct one-time semi-structured qualitative interviews with the Virtual Collaborative Care Clinic pharmacists. The Virtual Collaborative Care Clinic pharmacist will be interviewed to assess implementation factors including the auto-referral process and open-ended questions on the process and suggestions for improvement. | Up to 2 months Post Baseline | 
| Replicability to other health systems as assessed by survey responses | Primary Care Physicians and vCCC Pharmacists will be asked for feedback on replicability to other health systems via a survey. Brief, validated scales will be delivered via email (REDCap surveys) to assess the construct of replicability to other health systems. | Baseline | 
| Replicability to other health systems as assessed by survey responses | Primary Care Physicians and vCCC Pharmacists will be asked for feedback on replicability to other health systems via a survey. Brief, validated scales will be delivered via email (REDCap surveys) to assess the construct of replicability to other health systems. | 3 Months Post Baseline | 
| Replicability to other health systems as assessed by Physician Advisory Board meetings discussion | Members of the Physician Advisory Board will be asked for feedback on replicability to other health systems during the monthly Physician Advisory Board meetings. The meetings will be recorded and summarized. | Through study completion, an average of 9 months | 
| Replicability to other health systems as assessed by vCCC Pharmacist Interviews | vCCC Pharmacists will be asked for feedback on replicability to other health systems. We will conduct one-time semi-structured qualitative interviews including open-ended questions. | Up to 2 months Post Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hypertension, Cognitive Decline, Mild Cognitive Decline, Memory Loss, Memory Disorders, Memory Impairment, Blood Pressure, Blood Pressure, High