Efficacy of Web-based Feedback to Improve Blood Pressure Control

基于网络的反馈改善血压控制的功效

• 批准号: 7024750
• 负责人: CHRISTOPHER N. SCIAMANNA
• 金额: $ 46.38万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7024750
• 关键词: Internet; antihypertensive agents; behavioral /social science research tag; blood pressure; cardiovascular disorder education; clinical research; clinical trials; computer assisted medical decision making; cost effectiveness; creatinine; educational resource design /development; health care service evaluation; health services research tag; human subject; human therapy evaluation; hypertension; interview; lifestyle; medical records; patient care personnel relations; patient oriented research; potassium; primary care physician; questionnaires

DESCRIPTION (provided by applicant): Hypertension is one of the most important underlying causes of morbidity and mortality in the US. Despite the existence of evidence-based hypertension guidelines, fewer than one in three patients (29 percent) with hypertension have their blood pressure under control. Though patients with hypertension often do not adhere to treatments, physician decisions have a significant role in this problem. Prompting patients to ask doctors specific questions has proven widely effective in improving preventive care, but its effect on blood pressure control has not been studied. We have developed a web-based program to be used by patients with high blood pressure before doctor visits. The program asks patients questions about their medications, their hypertension care and their blood pressure control. Based on these responses and guideline-based rules, patients are given personalized feedback. The feedback includes questions that the patient should consider asking their provider, such as "Would I benefit from keeping my systolic blood pressure less than 140?" along with supporting information and a link to a reputable website (e.g., NIH) for further reading on the topic. Given that patients tend to get tests and treatments that they ask their physicians for, the website is designed to activate patients to ask questions that lead to better blood pressure control. The main aim of the study is to test the efficacy of providing access to the hypertension module of the website. We will recruit primary care providers (26) and randomize them into two conditions, intervention (1C) and control (CC). Patients with hypertension (500), from each provider, will be recruited and given access to the hypertension module of the website (Intervention Condition) or the preventive services module (Control Condition), which serves as an active control condition. The primary outcome will be the percentage of patients in each group whose blood pressure is controlled, according to JNC7 criteria (<130/80 for patients with diabetes or chronic kidney disease, <140/90 for all other adults). We hypothesize that, after 12 months of access to the website, 60 percent of patients in the 1C will have their blood pressure controlled, compared to 40 percent of patients in the CC. Uncontrolled high blood pressure is one of the greatest threats to the public's health. This study seeks to test the effect of a web-based intervention that, by encouraging patient to ask specific questions during doctor visits, has the potential to improve blood pressure control. As three of four Americans now have access to the Internet, this intervention holds great promise for improving blood pressure control and for improving the public's health by improving the quality of care for other common, chronic illnesses.

描述（由申请人提供）：高血压是美国发病和死亡率最重要的根本原因之一。尽管存在基于证据的高血压指南，但患有高血压的三分之一的患者（29％）的血压受到控制。尽管高血压患者通常不遵守治疗，但医师的决定在此问题中起着重要作用。事实证明，促使患者提出特定问题已广泛有效地改善预防性护理，但尚未研究其对血压控制的影响。我们已经开发了一个基于Web的程序，可在医生就诊之前患有高血压的患者使用。该计划向患者询问有关他们的药物，高血压护理和血压控制的问题。根据这些回应和基于指南的规则，为患者提供个性化的反馈。反馈包括患者应该考虑询问其提供者的问题，例如“我可以从低于140的收缩压中受益？”以及支持信息以及指向知名网站（例如NIH）的链接，以进一步阅读该主题。鉴于患者倾向于获得他们要求医生的测试和治疗，因此该网站旨在激活患者，以提出导致更好的血压控制的问题。该研究的主要目的是测试提供对网站高血压模块的访问的功效。我们将招募初级保健提供者（26），并将其随机分为两个条件，即干预（1C）和对照（CC）。每位提供者的高血压患者（500）将被招募，并可以访问网站的高血压模块（干预条件）或预防服务模块（控制状态），该模块（控制状态）可作为主动控制条件。根据JNC7标准，每组血压受到控制的患者的百分比（糖尿病或慢性肾脏疾病的患者<130/80 <130/80，所有其他成年人<140/90）。我们假设，在访问该网站12个月后，1C中有60％的患者将控制血压，而CC中有40％的患者。不受控制的高血压是对公众健康的最大威胁之一。这项研究旨在测试基于网络的干预措施的效果，该干预措施通过鼓励患者在就诊期间提出特定问题，具有改善血压控制的潜力。由于四个美国人中的三个现在可以访问互联网，因此这种干预措施具有改善血压控制并通过提高其他常见的慢性疾病的护理质量来改善公众健康的巨大希望。