Hypertension affects more than 65 million people in the US with African Americans disproportionably affected. Untreated hypertension is associated with an increased risk for myocardial infractions, sudden death, stroke, and renal failure. Despite the importance of controlling hypertension and available therapy, the clinical application of well-established guidelines has been disappointing. Inadequate blood pressure control remains all too common. To advance care for chronic conditions such as hypertension, the patient-provider relationship needs to mature into a Partnership. Patient empowerment must be increased through education, selfmanagement, collaborative goal setting, and treatment planning. Patient-Centered Care (PCC) has been implemented for acute ambulatory settings. However, chronic disease management and prevention presents some unique challenges for PCC since the patient is followed by episodic office visits with often long and variable times between visits. For chronic disease care, innovative strategies are needed to support the constructs of PCC in an efficient and cost-effective manner. We believe that telemedicine, by empowering the patient and strengthening the patient-provider relationship, can support a chronic care model of PCC in a realistic and sustainable manner. ? ? Through previous grant funding, we have established a Telemedicine System for chronic disease management. Based on a personal health record, we have successfully used this system in diverse populations, in over 600 patients, and in multiple disease states (heart failure, CVD risk reduction, gestational diabetes). In this proposal, we will enhance this Telemedicine system to support PCC by increasing access, incorporating hypertension treatment guideline, quality measures, automating reminders and feedback for both patients and health care providers, and the ability of our personal health record (PHR) to exchange data between other HL7-compliant electronic medical record systems. ? ? Inner-city, primarily African-American patients (N=170) with uncontrolled hypertension (BP<140/90 mmHg) and who are followed by primary care physicians will be randomized to either a usual care or a telemedicine group (Telemedicine plus usual care). Blood pressure, weight, BMI, blood glucose and lipids, and physical activity will be measured at baseline and at 6 months. We hypothesize that more subjects in the telemedicine group will achieve goal blood pressure than in the control group. This will occur through increases in knowledge, self-management, shared decision-making, and improved doctor-patient interaction. Primary endpoint will be the proportion of subjects who achieve goal blood pressure. Secondary end-points will include: rate of self-monitoring, steps per day, weight, CVD knowledge, number of patients at medication guidelines, and increased satisfaction with practice. Telemedicine utilization will also be determined. We believe that telemedicine can facilitate PCC and reduce blood pressure in a cost effective manner. ? ? ? ?
