Electronic Communications and Home Blood Pressure Monitoring (e-BP) study: Design, delivery, and evaluation framework

Abstract

Background-Randomized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease; however, blood pressure remains inadequately treated in most affected individuals. This large gap continues despite the facts that more than 90% of adults with hypertension have health insurance, and hypertension is the leading cause of visits to the doctor. New approaches are needed to improve hypertension care. Objectives-The Electronic Communications and Home Blood PressureMonitoring (e-BP) study is a three-arm randomized controlled trial designed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care. The primary study outcomes are systolic, diastolic, and blood pressure control; secondary outcomes are medication adherence, patient self-efficacy, satisfaction and quality of life, and healthcare utilization and costs.Methods-Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address. Study participants are randomly assigned to three intervention groups: (a) usual care; (b) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website (with secure e-mail access to their healthcare provider, access to a shared medical record, prescription refill and other services); or (c) this plus pharmacist care management (collaborative care management between the patient, the pharmacist, and the patient's physician via a secure patient website and the electronic medical record).Conclusion-We will determine whether a new model of patient-centered care that leverages Web communications, self-monitoring, and collaborative care management improves hypertension control. If this model proves successful and cost-effective, similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension.

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

“…After assessing their titles and excluding those not mentioning any information pertinent to hypertension, BP, or medication adherence studies, 130 remained and their abstracts read. Of the 47 articles retrieved for full-text review, 32 were excluded for the following reasons: not an interventional study, [25][26][27] studied participants with a different disease not relevant to review, [28][29][30][31][32] did not include pharmacists in the study interventions, 33 presented pharmaceutical interventions and outcomes investigating neither adherence nor BP, [34][35][36][37] presented pharmaceutical interventions and outcomes investigating BP but not adherence, [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] investigated medication adherence outcome in the intervention group only and baseline adherence was not measured, 54 and not studies but reviews. 13,55 A total of 15 articles were included as full-text in our systematic review.…”

Test of an Interactive Voice Response Intervention to Improve Adherence to Controller Medications in Adults with Asthma

“…11 In addition, text messaging has been used to support adolescents with asthma 27 and diabetes. 28 Email interventions have been introduced to improve blood pressure treatment adherence, 12 and a variety of web-based interventions have been used to improve smoking cessation, 13 weight loss, 14 hypertension, 12 and chronic obstructive pulmonary disease. 29 Early reports from some communication technology projects have described patient response to using the telecommunication technology but did not report behavior or disease outcomes.…”

“…Speech recognition and text messaging programs have been designed to promote diabetes and asthma self management. 9 -11 E-mail and webbased interventions have targeted improved adherence to antihypertensive medications 12 as well as smoking cessation 13 and weight loss programs. 14 Although such interventions have been developed and described, few have been tested in randomized clinical trials.…”

Pilot Study of Providing Online Care in a Primary Care Setting

“…[3][4][5] Several articles have discussed electronic messaging (emails) as a way to improve efficiency by decreasing patient telephone calls to the physician's office. [6][7][8][9] Various reports have described the use of the Internet to manage conditions such as depression, 10,11 diabetes mellitus, 12 hypertension, 13,14 and sexually transmitted diseases 15 and also to assist with breastfeeding support, 16 previsit well child encounters, 17 and communication with patients in safety net practices. 18 Guidelines have been established for providing medical care on the Internet ("e-visits").…”