Hypertension telemanagement in blacks.

We propose evaluation of a multi-component home automated telemanagement system providing integrated support to both clinicians and patients in implementing hypertension treatment guidelines. In a randomized clinical study, 550 blacks with hypertension are followed for 18 months. The major components of the intervention and control groups are identical and are based on the current standard of care. For the purpose of this study, we define "standard of care" as the expected evidence-based care provided according to the current hypertension treatment guidelines. Although intervention and control groups are similar in terms of their care components, they differ in the mode of care delivery. For the control group the best attempt is made to deliver all components of a guideline-concordant care in a routine clinical environment whereas for the intervention group the routine clinical environment is enhanced with health information technology that assists clinicians and patients in working together in implementing treatment guidelines. The home automated telemanagement system guides patients in following their individualized treatment plans and helps care coordination team in monitoring the patient progress. The study design is aimed at addressing the main question of this trial: whether the addition of the information technology-enhanced care coordination in the routine primary care setting can improve delivery of evidence-based hypertension care in blacks. The outcome parameters include quality of life, medical care use, treatment compliance, psychosocial variables, and improvement in blood pressure control rates. The trial will provide insight on the potential impact of information technology-enhanced care coordination in blacks with poorly controlled hypertension.

[1]  W. J. Elliott,et al.  Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial , 2009 .

[2]  N. Artinian,et al.  Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. , 2001, Heart & lung : the journal of critical care.

[3]  Joseph Finkelstein,et al.  Acceptance of Telemanagement is High in Patients With Inflammatory Bowel Disease , 2006, Journal of clinical gastroenterology.

[4]  Joseph Finkelstein,et al.  Reducing depression stigma using a web-based program , 2007, Int. J. Medical Informatics.

[5]  D W Massaro,et al.  Information processing models: microscopes of the mind. , 1993, Annual review of psychology.

[6]  Joseph Finkelstein,et al.  Home Automated Telemanagement (HAT) System to Facilitate Self-Care of Patients with Chronic Diseases , 2003 .

[7]  Joseph Finkelstein,et al.  Feasibility of Promoting Smoking Cessation Among Methadone Users Using Multimedia Computer-Assisted Education , 2008, Journal of medical Internet research.

[8]  Howard Cabral,et al.  Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study , 2008, Journal of medical Internet research.

[9]  F Rhodes,et al.  Using Behavioral Theory in Computer-Based Health Promotion and Appraisal , 1997, Health education & behavior : the official publication of the Society for Public Health Education.

[10]  Jakob Nielsen,et al.  Usability engineering , 1997, The Computer Science and Engineering Handbook.

[11]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[12]  W. Velicer,et al.  The Transtheoretical Model of Health Behavior Change , 1997, American journal of health promotion : AJHP.

[13]  E H Wagner,et al.  Chronic disease management: what will it take to improve care for chronic illness? , 1998, Effective clinical practice : ECP.

[14]  W. Hargreaves,et al.  Assessment of client/patient satisfaction: development of a general scale. , 1979, Evaluation and program planning.

[15]  Joseph Finkelstein,et al.  Feasibility and Acceptance of a Home Telemanagement System in Patients with Inflammatory Bowel Disease: A 6-Month Pilot Study , 2007, Digestive Diseases and Sciences.

[16]  G. Hripcsak,et al.  Internet-based home asthma telemonitoring: can patients handle the technology? , 2000, Chest.

[17]  B. Davis,et al.  Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). , 2002, Journal of clinical hypertension.

[18]  M. Rogers,et al.  Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension , 2001, Annals of Internal Medicine.

[19]  J. Avorn,et al.  Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. , 2001, Archives of internal medicine.

[20]  Joseph Finkelstein,et al.  Development and Implementation of the Home Asthma Telemonitoring (HAT) System to Facilitate Asthma Self-Care , 2001, MedInfo.

[21]  Vandana Sundaram,et al.  Quality Improvement Strategies for Hypertension Management: A Systematic Review , 2006, Medical care.

[22]  Joseph Finkelstein,et al.  Acceptance and expectations of information technology to support hypertension self-care in African Americans: a qualitative inquiry. , 2007, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[23]  A. Bandura Social learning theory , 1977 .

[24]  Joseph Finkelstein,et al.  Home-based physical telerehabilitation in patients with multiple sclerosis: a pilot study. , 2008, Journal of rehabilitation research and development.

[25]  Joseph Finkelstein,et al.  Randomized study of different anti-stigma media. , 2008, Patient education and counseling.