Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework.
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.


OBJECTIVE
The Electronic Communications and Home Blood Pressure Monitoring (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).


CONCLUSIONS
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.
Green
Beverly B
BB
Group Health Permanente, Seattle, WA, USA. green.b@ghc.org
Ralston
James D
JD
Fishman
Paul A
PA
Catz
Sheryl L
SL
Cook
Andrea
A
Carlson
Jim
J
Tyll
Lynda
L
Carrell
David
D
Thompson
Robert S
RS
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D034742:Electronic Mail; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010595:Pharmacists; D017064:Process Assessment, Health Care; D011788:Quality of Life; D040242:Risk Reduction Behavior; D017216:Telemedicine / Q000191:economics
D000959:Antihypertensive Agents