MI-BP: mHealth to Improve Blood Pressure Control in Hypertensive African Americans

MI-BP：移动医疗改善非洲裔美国人高血压患者的血压控制

基本信息

批准号：
9741169
负责人：
Lorraine R Buis
金额：
$ 69.65万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-01 至 2024-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9741169
关键词：
Accident and Emergency department Adherence Adoption Affect African American Age Ambulatory Care American Antihypertensive Agents Behavior Behavioral Blood Pressure Car Phone Cardiovascular system Caring Cellular Phone Communities Dependence Ethnic Origin Event Face Goals Health Health behavior Health behavior change Healthcare Systems Hypertension Individual Intake Internet Intervention Investigation Link Literature Measures Mediating Mediator of activation protein Michigan Minority Monitor Morbidity - disease rate Motivation Outcome Paper Participant Patients Pattern Pharmaceutical Preparations Physical activity Physicians Plant Roots Population Primary Health Care Race Randomized Randomized Controlled Trials Recommendation Research Research Personnel Resources Risk Self Blood Pressure Monitoring Self Care Self Management Sodium Stream Target Populations Testing Time Traction Work arm base behavior change behavioral/social science blood pressure reduction blood pressure regulation cardiovascular risk factor cohort comparison intervention cost effective cost effectiveness cost-effectiveness evaluation efficacy testing experience health disparity healthy weight high risk hypertension control improved mHealth medication compliance minority communities mortality premature pressure programs public health relevance recruit secondary analysis secondary outcome skills social science research success tailored messaging treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Hypertension (HTN), one of the most important cardiovascular risk factors, affects more than 78 million Americans. Compared to other races/ethnicities, African Americans are more likely to develop HTN and have lower rates of blood pressure (BP) control, increasing risk of premature cardiovascular morbidity and mortality. African Americans are also more likely to utilize the emergency department (ED) for ambulatory care, a factor strongly linked with adverse cardiovascular events among patients with HTN. This high ED utilization may reflect poor access to primary care, and suggests the challenge people face regarding self-management. Because BP is routinely measured in the ED, it is an ideal setting to both identify patients with uncontrolled HTN and intercede, particularly in African American communities where regular interaction with the health care system may be lacking. Recommendations to improve HTN-related outcomes have been consistent for decades: maintain a healthy weight, reduce daily sodium intake, increase physical activity, and comply with antihypertensive therapy as prescribed. Despite tremendous evidence supporting these recommendations, facilitating the necessary behavior changes in patients with HTN remains a challenge, especially in African Americans who reside in urban, under-resourced settings. Daily intensive self-monitoring is efficacious and is often the cornerstone of many behavior change interventions; however, long-term sustainment can be difficult to achieve, especially in minority populations residing in urban, under-resourced communities. Mobile health (mHealth) has demonstrated success with behavior change, and may increase long-term self- monitoring. Given high cell phone adoption rates in minority communities, and higher rates of reliance on mobile Internet access, mHealth strategies are particularly well suited to urban African American populations. Currently, there exists traction among physicians and patients for mHealth HTN interventions, but such an approach to improve BP in hypertensive patients has not been tested. This study seeks to improve HTN-related outcomes in a cohort of African Americans with uncontrolled HTN between the ages of 25 and 55, and is guided by three specific aims. Aim 1: We will determine the efficacy of MI-BP, a comprehensive, multiple health behavior change mobile intervention, on BP control at one year in a randomized controlled trial (RCT) of the intervention compared to paper-based self- monitoring and usual care controls. Aim 2: We will determine the effect of MI-BP on secondary outcomes (physical activity, sodium intake, medication adherence) compared to paper-based self- monitoring and usual care controls, in a one year RCT. Aim 3: We will evaluate the cost-effectiveness of MI-BP compared to paper-based self-monitoring and usual care controls.

描述（由适用提供）：高血压（HTN）是最重要的心血管危险因素之一，影响了超过7800万美国人。与其他种族/族裔相比，非裔美国人更有可能发展HTN，并且血压控制率较低，从而增加了心血管发病过早的风险。非裔美国人也更有可能利用急诊室（ED）进行门诊护理，这是与HTN患者之间不良心血管事件密切相关的因素。这种高ED利用率可能反映出获得初级保健的机会不佳，并提出人们在自我管理方面面临的挑战。由于BP在ED中常规测量，因此既可以识别出不受控制的HTN和代祷的患者，尤其是在可能缺乏与医疗保健系统的定期互动的非裔美国人社区中，这是理想的环境。几十年来，提出改善与HTN相关结果的建议一直保持一致：保持健康的体重，减少每日钠摄入量，增加体育锻炼，并遵守处方的降压治疗。尽管有大量证据支持这些建议，但支持HTN患者的必要行为变化仍然是一个挑战，尤其是在居住在城市，资源不足的环境中的非裔美国人中。每日密集的自我监控是有效的，通常是许多行为改变干预措施的基石；但是，长期的维持可能很难实现，尤其是在居住在城市，资源不足社区中的少数民族中。移动健康（MHealth）在行为改变方面表现出成功，并可能增加长期的自我监测。鉴于少数族裔社区的手机采用率很高，并且在移动互联网访问方面的退休率更高，因此MHealth策略特别适合城市非裔美国人人口。目前，医生和患者的MHealth HTN干预措施存在牵引力，但是这种改善高血压患者BP的方法尚未进行测试。这项研究旨在改善与HTN相关的结果，其中25至55岁之间的HTN不受控制的HTN队列，并受三个特定目标的指导。目标1：我们的目标2：与基于纸质的自我监测和常规护理控制相比，在干预的随机对照试验（RCT）中，MI-BP（一种全面的，多重健康行为变化移动干预）对BP控制的有效性。目标2：与基于纸张的自我监测和常规护理控制相比，我们将确定MI-BP对次级结果（体育活动，钠摄入量，药物依从性）的影响。 AIM 3：我们将评估MI-BP的成本效益与基于纸张的自我监控和通常的护理控制。