Internet-based patient– primary care physician–cardiologist integrated management model of hypertension in China: study protocol for a multicentre randomised controlled trial

Abstract

IntroductionThe control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient–primary care physician–cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels.Methods and analysisThis is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0.Ethics and disseminationThis study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals.Trial registration numberChiCTR2000030677.

Combined Management can Decrease Blood Pressure: A Health-seeking Behaviors Investigation among Hypertensive Patients in Urban Communities in China

“…But how to operate the combined management e ciently needs further study. We have conducted a study to evaluate the clinical e cacy and health economics effect of an internet-based patient-primary care physiciancardiologist integrated management model of hypertension in China [29]. We are looking forward to the results.…”

A cross‐sectional study on the ability of physicians to hypertension management in China's Sichuan Tibetan rural area

“…The following physician‐related issues in hypertension management were highlighted based on our survey: the physicians (1) neglected the importance of a healthy lifestyle and methods to behavioral and lifestyle changes; (2) lacked confidence to optimally perform routine activities for hypertension management; and (3) underestimated the cardiovascular risks associated with blood pressure; they did not effectively prescribe antihypertensive drugs based on the cardiovascular risk at the individual level. In the future, we plan to create programs for these physicians with an emphasis on hypertension treatment and management, along with establishing a communication system between the Tibetan physicians and hypertension professionals working at tertiary hospitals, 26 aiming at improving the physicians’ abilities and confidence in terms of hypertension management.…”

“…Previously, our team had launched a hypertension management improvement project 26 . We developed an Internet‐based hypertension management system, the Red Shine Chronic Disease Management System (RSCDMS), aiming at providing patients with high‐quality management by physicians under the guidance of specialists to help these physicians improve their clinical disease management abilities 26 .…”

“…15 Previously, our team had launched a hypertension management improvement project. 26 We developed an Internet-based hypertension management system, the Red Shine Chronic Disease Management System (RSCDMS), aiming at providing patients with high-quality management by physicians under the guidance of specialists to help these physicians improve their clinical disease management abilities. 26 We hypothesized that by using this system to address the issues identified above, online training courses could be provided based on the physicians' needs, and a real-time hierarchical medical system could be created for the high-altitude remote areas.…”

“…lacked confidence to optimally perform routine activities for hypertension management; and (3) underestimated the cardiovascular risks associated with blood pressure; they did not effectively prescribe antihypertensive drugs based on the cardiovascular risk at the individual level. In the future, we plan to create programs for these physicians with an emphasis on hypertension treatment and management, along with establishing a communication system between the Tibetan physicians and hypertension professionals working at tertiary hospitals,26 aiming at improving the physicians' abilities and confidence in terms of hypertension management.Despite the physicians' poor educational background, the training currently provided was not effective for the physicians' chronic disease management abilities. Some physicians were aware of the problem, and were willing to undergo further training to improve their management abilities.…”