Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure
| Autor: | Benjamin F. Crabtree, Jeffrey P. Anderson, Patrick J. O'Connor, Jo Ann M. Sperl-Hillen, Rae Ann Williams, Karen L. Margolis, Rashmi Sharma, Beverly B. Green, Jeanette Y. Ziegenfuss, A. Lauren Crain, Deepika Appana, Dan Rehrauer, Mary Sue Beran, Nicole K. Trower, Christine K Norton, Amy J. Kodet, Anna R. Bergdall, Leif I. Solberg, Pamala A. Pawloski, Patricia K Haugen, Zeke J McKinney |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Comparative Effectiveness Research Adolescent Comparative effectiveness research Population Pharmacist Telehealth Pharmacists Young Adult 03 medical and health sciences 0302 clinical medicine Patient experience Humans Medicine Pharmacology (medical) 030212 general & internal medicine Cluster randomised controlled trial education Aged Aged 80 and over education.field_of_study 030505 public health Primary Health Care business.industry General Medicine Blood Pressure Monitoring Ambulatory Middle Aged medicine.disease Telemedicine Clinical pharmacy Research Design Hypertension Female Implementation research Medical emergency 0305 other medical science business |
| Zdroj: | Contemporary Clinical Trials. 92:105939 |
| ISSN: | 1551-7144 |
| Popis: | Background Uncontrolled hypertension is the largest single contributor to all-cause and cardiovascular mortality in the U.S. population. Nurse- and pharmacist-led team-based care and telehealth care interventions have been shown to result in large and lasting improvements in blood pressure (BP); however, it is unclear how successfully these can be implemented at scale in real-world settings. It is also uncertain how telehealth interventions impact patient experience compared to traditional clinic-based care. Aims/objectives To compare the effects of two evidence-based blood pressure care strategies in the primary care setting: (1) best-practice clinic-based care and (2) telehealth care with home BP telemonitoring and management by a clinical pharmacist. To evaluate implementation using mixed-methods supported by the RE-AIM framework and Consolidated Framework for Implementation Research. Methods The design is a cluster-randomized comparative effectiveness pragmatic trial in 21 primary care clinics (9 clinic-based care, 12 telehealth care). Adult patients (age 18–85) with hypertension are enrolled via automated electronic health record (EHR) tools during primary care encounters if BP is elevated to ≥150/95 mmHg at two consecutive visits. The primary outcome is change in systolic BP over 12 months as extracted from the EHR. Secondary outcomes are change in key patient-reported outcomes over 6 months as measured by surveys. Qualitative data are collected at various time points to investigate implementation barriers and help explain intervention effects. Conclusion This pragmatic trial aims to inform health systems about the benefits, strengths, and limitations of implementing home BP telemonitoring with pharmacist management for uncontrolled hypertension in real-world primary care settings. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect