Development of an implementation-ready antihypertensive self-titration intervention to improve US blood pressure control

开发可立即实施的抗高血压自我滴定干预措施，以改善美国血压控制

基本信息

批准号：
10676839
负责人：
Nancy Haff
金额：
$ 17.26万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
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：
2022-08-04 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10676839
关键词：
Acceleration Adherence Adoption Adult Algorithms Antihypertensive Agents Area Biometry Blood Pressure Cardiology Cardiometabolic Disease Cardiovascular Diseases Cardiovascular system Caring Cessation of life Characteristics Charge Clinic Clinical Coronary heart disease Crystallization Data Data Set Development Diagnosis Disease Disease Management Effectiveness Effectiveness of Interventions Ensure Environment Equipoise Evidence based treatment Family member Goals Grant Guidelines Health Services Research Heart failure Home Hypertension Immersion Implementation readiness Infrastructure Intervention Interview Leadership Literature Mentors Mentorship Mission Modeling Monitor Morbidity - disease rate Myocardial Infarction National Heart, Lung, and Blood Institute Patient Care Patient Preferences Patients Pattern Pharmaceutical Preparations Population Prevention Preventive Primary Care Primary Care Physician Protocols documentation Provider Publishing Qualitative Methods Randomized Reaction Recommendation Regimen Research Research Methodology Review Literature Risk Reduction Self Efficacy Self Management Stroke Structure Testing Titrations Training Work Writing blood pressure control blood pressure reduction career career development cost cost effectiveness design disorder prevention effectiveness testing follow-up hypertension control hypertension treatment implementation design implementation facilitators implementation science improved innovation medication compliance medication nonadherence mortality novel strategies patient oriented practice factors primary care practice primary care setting programs provider factors randomized trial routine care routine practice sociodemographics systematic review team-based care treatment choice treatment guidelines usability

项目摘要

Nearly 1 in 2 US adults has hypertension, and it is a leading cause of myocardial infarction, stroke, and death. Despite the importance of hypertension and the widespread availability of medication treatment, only 44% of patients had controlled blood pressures in 2018. This is in part due to the way in which we deliver care, and new strategies are needed to achieve better blood pressure control. Team-based care with medication titration by a non-physician is a promising approach, but the cost and infrastructure required make this option less feasible. An alternative strategy is to have patients self-manage their own hypertension by checking blood pressures and following an algorithm, pre-planned between the patient and primary care doctor, to intensify their medications at home. Despite evidence for the effectiveness and cost- effectiveness of this approach, it has not yet been incorporated into routine care. In this project, we propose to develop an implementation-ready antihypertensive self-titration intervention informed by qualitative interviews and real-world assessments of antihypertensive adherence. The proposed aims are to: (1) explore barriers and facilitators to the implementation of antihypertensive self-titration in routine US primary care; (2) assess adherence to antihypertensive treatments; and (3) develop an implementation-ready antihypertensive self- titration protocol, perform usability testing, and prepare a proposal for a pragmatic, randomized trial to test the intervention’s effectiveness. The overarching goal of the project is to develop an innovative alternative model of hypertension care that has the potential to improve blood pressure control, patient self-efficacy, and disease understanding Dr. Haff is a practicing primary care physician committed to a career in research to improve the prevention and treatment of cardiometabolic disease, and this proposal includes a training plan that will accelerate her career development in the areas of implementation science, qualitative methods, health services research methods, and scientific writing. The mentorship team, led by Niteesh Choudhry, an expert in health services research and implementation science related to cardiometabolic disease, includes well-known experts in preventive cardiology (Paul Ridker, co- mentor), biostatistics (Robert Glynn, co-mentor), and implementation science and qualitative methods (Karen Emmons, co-mentor), and will ensure successful completion of the proposed project and training. By the conclusion of this program, Dr. Haff will be able to independently design, target, and evaluate interventions for cardiometabolic disease. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.

近二分之一的美国成年人患有高血压，这是心肌梗塞的主要原因，尽管高血压很重要并且广泛存在。通过药物治疗，2018年只有44%的患者控制了血压。这是在部分原因在于我们提供护理的方式，需要新的策略来实现更好的目标由非医生进行药物滴定的团队护理是一种血压控制。这是一种很有前途的方法，但所需的成本和基础设施使得这种选择不太可行。另一种策略是让患者通过检查血液来自我管理高血压压力并遵循患者和初级保健医生之间预先计划的算法，尽管有证据表明其有效性和成本- 这种方法的有效性，目前尚未纳入日常护理中。在这个项目中，我们建议开发一种可供实施的抗高血压自我滴定法通过定性访谈和抗高血压药物的真实评估进行干预拟议的目标是： (1) 探索实施的障碍和促进因素。抗高血压自我滴定在美国常规初级保健中的应用（2）评估依从性；抗高血压治疗；(3) 制定可供实施的抗高血压自我治疗方案；滴定方案，进行可用性测试，并准备一份实用的、随机的提案测试干预措施有效性的试验该项目的总体目标是开发一种干预措施。高血压护理的创新替代模式有改善血液的潜力压力控制、患者自我效能和疾病理解哈夫博士是一名执业初级保健医生，致力于研究以改善心脏代谢疾病的预防和治疗，该提案包括培训计划这将加速她在实施科学、定性领域的职业发展方法、卫生服务研究方法和科学写作，由指导团队领导。 Niteesh Choudhry，卫生服务研究和实施科学方面的专家心脏代谢疾病，包括预防心脏病学领域的知名专家（Paul Ridker，共同导师）、生物统计学（罗伯特·格林，共同导师）以及实施科学和定性方法（凯伦·埃蒙斯，共同导师），并将确保成功完成拟议的完成该计划后，哈夫博士将能够独立进行项目和培训。设计、瞄准和评估心脏代谢疾病的干预措施。拟议的 K23 将成为计划中的 R01 级应用的宝贵试点工作。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Frequency of Quarterly Self-reported Health-Related Social Needs Among Older Adults, 2020.

2020 年老年人每季度自我报告的与健康相关的社会需求的频率。

DOI：
发表时间：
2022-06-01
期刊：
影响因子：
13.8
作者：
Haff, Nancy;Choudhry, Niteesh K;Bhatkhande, Gauri;Li, Yong;Antol, Dana Drzayich;Renda, Andrew;Lauffenburger, Julie C
通讯作者：
Lauffenburger, Julie C

Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain: The SPINE CARE Randomized Clinical Trial.

生物心理社会干预或姿势疗法对急性和亚急性脊柱疼痛患者的残疾和医疗保健支出的影响：SPINE CARE 随机临床试验。

DOI：
发表时间：
2022-12-20
期刊：
影响因子：
0
作者：
Choudhry, Niteesh K;Fifer, Sheila;Fontanet, Constance P;Archer, Kristin R;Sears, Ellen;Bhatkhande, Gauri;Haff, Nancy;Ghazinouri, Roya;Coronado, Rogelio A;Schneider, Byron J;Butterworth, Susan W;Deogun, Harvinder;Cooper, Angelina;Hsu, Eugene
通讯作者：
Hsu, Eugene

Gabapentinoid Use by Self-Reported Indication and Level of Evidence.

根据自我报告的适应症和证据水平使用加巴喷丁。

DOI：
发表时间：
2024-01
期刊：
影响因子：
5.7
作者：
Chaitoff, Alexander;Choudhry, Niteesh K;Haff, Nancy;Lauffenburger, Julie C
通讯作者：
Lauffenburger, Julie C

Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study.

解开药物的贡献：老年人的抗胆碱能负担与个体药物相关：一项基于人群的横断面研究。

DOI：
发表时间：
2024-01-10
期刊：
影响因子：
4.1
作者：
Bhatkhande, Gauri;Choudhry, Niteesh K;Mahesri, Mufaddal;Haff, Nancy;Lauffenburger, Julie C
通讯作者：
Lauffenburger, Julie C