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：
10644984
负责人：
MATTHEW F MULDOON
金额：
$ 71.6万
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/10644984
关键词：
Address Adherence Advisory Committees Affect Antihypertensive Agents Articulation Blood Pressure Blood Pressure Monitors Cardiovascular Diseases Cardiovascular system Caring Cellular Phone Chronic Clinical Clinical Trials Cooperative Group Clinical assessments Communication Data Devices Diastolic blood pressure Disadvantaged Disparity Disparity population Education Educational Curriculum Electronic Health Record Geography Health Health Resources Health Services Accessibility Health education Health system Healthcare Systems Home Home Blood Pressure Monitoring 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 Reporting Research Resources Route Rural Rural Health Rural Population SARS coronavirus Self Care Self Efficacy Social Network Social isolation Surgeon Text Visit arm barrier to care blood pressure control blood pressure medication clinical encounter comparison control cost digital digital health digital technology effectiveness testing experience health application health care availability health care service utilization health literacy health related quality of life hypertension control hypertension treatment hypertensive improved indexing intervention effect intervention participants literacy low health literacy mHealth medication compliance mortality pandemic disease patient engagement patient oriented primary outcome programs randomized, clinical trials recruit remote assessment rural America rural patients rural setting rurality secondary outcome social social determinants social disparities social health determinants standard care success treatment and outcome virtual

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 2020 年外科医生杂志中可改变的主要心血管疾病病因。控制高血压行动呼吁阐明了多层次策略的关键相关性，以解决高血压问题影响 HTN 控制的社会决定因素和获得护理的机会。农村卫生鸿沟的挑战：与提供者的地理距离、社会隔离、有限的社交资源和低健康素养率高我们开发并验证了基于智能手机的方法。家庭血压监测 (HBPM) 计划，称为 MyBP，并已证明 MyBP 的成功促进了 HBPM 的依从性，改善了血压 (BP) 控制，并增强了患者的能力我们现在将 MyBP 改编为虚拟代理，称为 MyBP Coach，并利用我们的经验。与此类代理一起提供纵向健康教育、同理心指导、监测和适应性在这里，以患者咨询为指导，为患有心血管疾病的农村个体提供以患者为中心的指导。委员会，我们为农村个人提供 MyBP Coach 作为个性化课程，以促进和支持 HBPM；高血压治疗依从性；我们将评估 6- 临床遭遇的准备；以及增强的问题解决和参与。月 MyBP Coach 干预单中心、平行组临床试验，将 334 名患有以下疾病的患者随机分组 HTN 控制不佳（2 次门诊时收缩压 150-199 或舒张压 95-119 mm Hg）至 (1) HBPM 使用 MyBP Coach；或 (2) 控制装置，包括 HBPM 和带有一般健康应用程序的智能手机 (WebMD)。对于干预和控制，我们向忠诚者提供 HBPM 摘要以改善 HTN。加强农村高血压患者管理。 12 个月试验期间的药物治疗；并跟踪 (a) 6- 和 12- 抗高血压药物的依从性所覆盖天数的月比例以及 (b) 6 个月遵守 HBPM 我们的目标是：(1) 检查效果。 MyBP Coach 在 6 个月时对血压进行干预并在 12 个月时评估其效果的可持续性 (2)；评估干预措施对 BP 药物和 HBPM 依从性的影响；以及 (3) 确定干预对患者报告的结果的影响，包括生活质量、参与度和社交能力我们的试验利用了我们整个农村 PA 的卫生系统基础设施，这是一种常见的电子卫生。我们记录了我们大型医疗保健系统的情况，并建立了农村临床合作伙伴关系。我们之前曾申请招募地理上偏僻、健康状况和数字能力有限的农村个人识字、进行远程评估并提供类似的基于智能手机的资源和指导。预期结果：在这个项目中，我们将评估可扩展且以患者为中心的干预措施，以改善血压控制、药物治疗和 HBPM 依从性以及患者报告的结果（如果证明成功）。可以广泛传播干预措施，以改善高血压控制不佳的农村患者的护理。