Multilevel mobile health program to improve rural hypertension

多层次移动医疗项目改善农村高血压

基本信息

批准号：
10338415
负责人：
MATTHEW F MULDOON
金额：
$ 72.58万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10338415
关键词：
Address Adherence Advisory Committees Affect Antihypertensive Agents Blood Pressure Blood Pressure Monitors COVID-19 pandemic Cardiovascular Diseases Cardiovascular system Caring Cellular Phone Chronic Clinical Clinical Trials Cooperative Group Communication Data Devices Diastolic blood pressure Disadvantaged Education Educational Curriculum Electronic Health Record Empathy Geography Health Health Resources Health Services Accessibility Health education Health system Healthcare Systems Home Hypertension Income Individual Information Systems Infrastructure Instruction Intervention Literature Measurement Measures Methods Monitor Morbidity - disease rate Outcome Participant Patient Outcomes Assessments Patient-Centered Care Patients Pharmaceutical Preparations Pharmacotherapy Pharmacy facility Preparation Prevalence Problem Solving Provider Public Health Quality of life Randomized Randomized Clinical Trials Reading Reporting Research Resources Route Rural Rural Health SARS coronavirus Self Care Self Efficacy Social Network Social isolation Surgeon Technology Text Treatment outcome Visit arm barrier to care base blood pressure control blood pressure medication care outcomes clinical encounter cost digital digital health disadvantaged population effectiveness testing experience health application health care availability health care service utilization health literacy health related quality of life hypertension control hypertension treatment hypertensive implementation barriers improved indexing intervention effect intervention participants literacy mHealth medication compliance mortality patient engagement patient oriented primary outcome programs recruit remote assessment rural America rural patients rural setting rurality secondary outcome social social determinants social disadvantage social health determinants standard care success therapy adherence virtual

Address Adherence Advisory Committees Affect Antihypertensive Agents Blood Pressure Blood Pressure Monitors COVID-19 pandemic Cardiovascular Diseases Cardiovascular system Caring Cellular Phone Chronic Clinical Clinical Trials Cooperative Group Communication Data Devices Diastolic blood pressure Disadvantaged Education Educational Curriculum Electronic Health Record Empathy Geography Health Health Resources Health Services Accessibility Health education Health system Healthcare Systems Home Hypertension Income Individual Information Systems Infrastructure Instruction Intervention Literature Measurement Measures Methods Monitor Morbidity - disease rate Outcome Participant Patient Outcomes Assessments Patient-Centered Care Patients Pharmaceutical Preparations Pharmacotherapy Pharmacy facility Preparation Prevalence Problem Solving Provider Public Health Quality of life Randomized Randomized Clinical Trials Reading Reporting Research Resources Route Rural Rural Health SARS coronavirus Self Care Self Efficacy Social Network Social isolation Surgeon Technology Text Treatment outcome Visit arm barrier to care base blood pressure control blood pressure medication care outcomes clinical encounter cost digital digital health disadvantaged population effectiveness testing experience health application health care availability health care service utilization health literacy health related quality of life hypertension control hypertension treatment hypertensive implementation barriers improved indexing intervention effect intervention participants literacy mHealth medication compliance mortality patient engagement patient oriented primary outcome programs recruit remote assessment rural America rural patients rural setting rurality secondary outcome social social determinants social disadvantage social health determinants standard care success therapy adherence virtual

展开

项目摘要

Hypertension (HTN) is the leading modifiable cause of cardiovascular disease. The Surgeon General’s 2020 Call to Action to Control Hypertension articulated the critical relevance of multilevel strategies to address the social determinants and access to care that affect HTN control. Rural individuals experience the additional challenges of the rural health divide: geographic distance from providers, social isolation, limited social resources, and high rates of low health literacy. We have developed and validated a smartphone-based program for home-based blood pressure monitoring (HBPM), termed MyBP, and have demonstrated the success of MyBP to promote adherence to HBPM, improve blood pressure (BP) control, and enhance patient engagement. We now adapt MyBP as a virtual agent, termed MyBP Coach, and leverage our experience with such agents to provide longitudinal health education, empathic guidance, monitoring, and adaptable patient-centered coaching to rural individuals with cardiovascular disease. Here, guided by a patient advisory committee, we provide MyBP Coach to rural individuals as a personalized curriculum to promote and support HBPM; HTN education; medication adherence; non-pharmacologic strategies for HTN management; preparation for the clinical encounter; and enhanced problem-solving and engagement. We will evaluate the 6- month MyBP Coach intervention in a single-center, parallel group clinical trial, randomizing 334 patients with poorly controlled HTN (systolic BP 150-199 or diastolic BP 95-119 mm Hg at 2 ambulatory visits) to (1) HBPM with MyBP Coach; or (2) the control, consisting of HBPM and a smartphone with a general health application (WebMD). For both intervention and control, we provide HBPM summaries to clinicians to improve HTN management for rural patients. We will follow treatment intensification and adjustment of hypertensive medications over the 12-month trial; and track (a) adherence to antihypertensive medication with 6- and 12- month proportion of days covered and (b) 6-month adherence to HBPM. Our aims are: (1) Examine the effect of the MyBP Coach intervention on BP at 6 months and assess the sustainability of its effects at 12 months; (2) Evaluate the effect of the intervention on adherence to BP medications and HBPM; and (3) Determine the effect of the intervention on patient-reported outcomes including quality of life, engagement, and social isolation. Our trial leverages our health system’s infrastructure across rural PA, a common electronic health record of our large health care system, and established rural clinical partnerships. We incorporate methods previously applied by us to recruit geographically isolated rural individuals with limited health and digital literacy, conduct remote assessments, and provide similar smartphone-based resources and instruction. Expected Results: In this project we will evaluate a scalable and patient-centered intervention to improve BP control, medication and HBPM adherence, and patient-reported outcomes. If proven successful, this intervention can be broadly disseminated to improve the care of rural patients with poorly controlled HTN.

高血压（HTN）是心血管疾病的主要修改原因。外科医生的2020年呼吁控制高血压的行动阐明了多级策略的关键相关性，以解决社会决定者并获得影响HTN控制的护理。农村人员会有额外的粗糙健康鸿沟的挑战：与提供者的地理距离，社会隔离，有限的社会资源和低健康素养的高率。我们已经开发并验证了基于智能手机的基于家庭的血压监测计划（HBPM），称为MYBP，并证明了 MYBP成功促进遵守HBPM，改善血压（BP）控制并增强患者订婚。现在，我们将MYBP改编为虚拟代理，称为MYBP教练，并利用我们的经验与此类代理商一起提供纵向健康教育，同理心指导，监测和适应性以患者为中心的辅导心血管疾病的农村人。在这里，在患者咨询的指导下委员会，我们为农村个人提供MYBP教练作为个性化课程，以促进和支持 hbpm; HTN教育；药物依从性； HTN管理的非药物策略；为临床遭遇做准备；并增强了解决问题和参与。我们将评估6- MYBP教练干预一次单中心，平行组临床试验，随机分组334例患者控制不良的HTN（收缩压150-199或2次卧床访问时舒张压BP 95-119 mm Hg）至（1）HBPM 与MYBP教练；或（2）由HBPM和具有一般健康应用的智能手机组成的控件（WebMD）。对于干预和控制，我们向临床医生提供HBPM摘要以改善HTN 粗糙患者的管理。我们将遵循治疗强化和高血压的调整在12个月试验中的药物；和（a）遵守6-和12-的降压药物覆盖天数的月份比例以及（b）遵守HBPM的6个月。我们的目标是：（1）检查效果 MYBP教练在6个月时对BP进行干预，并在12个月时评估其影响的可持续性；（2）评估干预对BP药物和HBPM依从性的影响；（3）确定干预对患者报告的结果的影响，包括生活质量，参与和社会隔离。我们的试验利用了跨PA农村的卫生系统的基础设施，这是一种普通的电子健康我们大型医疗保健系统的记录，并建立了农村临床伙伴关系。我们合并了方法以前我们曾被我们申请招募有限健康和数字的地理孤立的农村人识字，进行远程评估，并提供类似的基于智能手机的资源和说明。预期结果：在该项目中，我们将评估可扩展和以患者为中心的干预措施以改善BP 控制，药物和HBPM依从性以及患者报告的结果。如果被证明是成功的，干预措施可以广泛传播，以改善控制不良的HTN的粗糙患者的护理。