Studies employing telecommunication technologies have been successful in affecting the major components of chronic disease care including physician practice patterns, patient adherence to therapy, and patient-provider communication. To date there have been no studies evaluating a coordinated approach that simultaneously employs all of these components in an integrated framework linked to primary care practices. In this study we propose to evaluate a multicomponent telemanagement system providing an integrated support both to clinicians and patients in following hypertension treatment guidelines promulgated by JNC 7 Report. The Internet-based Home Automated Telemanagement (HAT) system implements a multi-component chronic disease management model which includes regular patient assessment, disease-specific education, control of patient adherence to treatment plans, promotion of therapeutic lifestyle changes, comprehensive patient-provider communication and computerized decision support. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of hypertension in African Americans (2) evaluate in a randomized controlled trial the magnitude of clinical impact of HAT on hypertension control rates in African Americans and examine cost-effectiveness of the proposed approach. Patients will have the HAT units (Internet-enabled computer connected to a blood pressure monitor and weight scale) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as blood pressure and body weight, which are automatically downloaded to the computer, and patient-reported parameters such as patient symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured hypertension education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker),. Overall, 550 African Americans with hypertension will be enrolled from 50 primary care clinics and will be followed for 18 months. The main study outcomes will be proportion of treated patients that achieve blood pressure goals meeting JNC 7 recommendations, and mean change in systolic and diastolic pressure. We will also explore HAT impact on physician awareness and adherence to JNC 7 guidelines, and patient ability to reach lifestyle modification goals recommended by the JNC 7 Report. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the African American patients with hypertension.
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