Hypertension
Conditions
Keywords
Clinic care, Team-based care, Medication Therapy Management (MTM), Telehealth, Cluster-randomized, Home blood pressure monitoring, Pharmacist
Brief summary
This pragmatic trial will compare two team-based care models for managing hypertension, Best Practice Clinic-based Care and Telehealth Care with pharmacist management, in a large care system in Minnesota. Clinics in the study are randomized to offer one of the two treatment models to participants with uncontrolled hypertension. The investigators aim to determine a) whether one model is more effective than the other for lowering patient's blood pressure and b) which model patients prefer.
Detailed description
The objectives of the study are: Aim 1: Compare the effects of two evidence-based strategies on lowering blood pressure and other outcomes important to patients: best-practice clinic-based care and home-based telehealth care. * Hypothesis 1.1: Compared with patients in clinics assigned to clinic-based care, patients in clinics assigned to telehealth care will have a 5 mm Hg greater change in systolic blood pressure over 12 months of follow-up. * Hypothesis 1.2: Compared with patients in clinics assigned to clinic-based care, patients in clinics assigned to telehealth care will report: a) fewer treatment side effects; b) better ratings of patient experience of hypertension care; and c) higher self-monitoring rates and confidence in self-care. Aim 2: Conduct an evaluation of the reach, adoption, implementation, and maintenance of the telehealth care and clinic-based care interventions using a mixed-methods approach supported by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR).
Interventions
OTHERBest Practice Clinic-Based Care
Relies primarily on the physician-medical assistant dyad and face-to-face visits to promote: 1. Improved recognition of uncontrolled BP at primary care encounters, 2. Therapeutic action to address uncontrolled BP at primary care encounters, 3. Reliable follow-up visits to re-assess uncontrolled BP every 2-4 weeks.
OTHERTelehealth Care
All elements of Clinic-Based Care are performed, plus a telemonitoring and pharmacist case management program is offered, specifically: 1. Referral to care by MTM pharmacist or Nurse Practitioner and receiving a home blood pressure telemonitoring device 2. Systematic home BP telemonitoring with data transmitted into patient medical record 3. Systematic home-based care by pharmacist or nurse practitioner via telephone and/or secure email
Sponsors
Patient-Centered Outcomes Research Institute
HealthPartners Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
Yes
Inclusion criteria
* Hypertension diagnosis code in medical record, twice in last 24 months * Attends study clinic for primary care visit within study period with uncontrolled blood pressure * Systolic blood pressure \>=150 mm Hg or Diastolic blood pressure \>=95 mm Hg at current visit * Systolic blood pressure \>=150 mm Hg or Diastolic blood pressure \>=95 mm Hg at most recent previous visit
Exclusion criteria
* Pregnancy * End Stage Kidney Disease * Patients in hospice care and patients who permanently reside in a nursing home
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Systolic Blood Pressure Between Baseline and 12 Months (mm Hg) | Trajectory over 12 months | Change in systolic BP, collected from medical records |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Reporting Monitoring BP at Least 2 Times Per Week at Six Months Follow-up | Baseline to 6 months | Patient report of monitoring BP at least 2 times per week |
| Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months. | Baseline to 6 months | Patient rating of 9-10 vs. 0-8 on a scale of 0 (low satisfaction) to 10 (high satisfaction). Developed from a scale used by Green, et al (2008). Citation: Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D,Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008;299:2857-2867. doi:10.1001/jama.299.24.2857 |
| Number of Participants Who Are Current Smokers at Twelve Months | Baseline to 12 months | Current smoker at 12 months |
| Number of Participants Reporting High Confidence in Reporting Contacting Care Team at Six Months Confidence in Managing Blood Pressure: Contact Care Team | Baseline to 6 months | Patient reported very or extremely confident in this aspect of BP management. |
| Number of Participants Reporting High Confidence in Keeping BP Below Target at Six Months | Baseline to 6 months | Patient reported very or extremely confident in this aspect of BP management. |
| Number of Participants Reporting Cough as a Side Effect of Antihypertensive Medications at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Reporting Dizziness as a Side Effect of Antihypertensive Medication at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Reporting Frequent Urination as a Side Effect of Antihypertensive Medication at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Reporting Leg/Foot Swelling as a Side Effect of Antihypertensive Medication at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Reporting Sexual Symptoms as a Side Effect of Antihypertensive Medication at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Reporting Tiredness as a Side Effect of Antihypertensive Medication at Six Months | Baseline to 6 months | Patient report that side effect is a problem |
| Number of Participants Who Report Decreasing Salt as Helpful for BP Self-management at Six Months | Baseline to 6 months | Patient report that activity is helpful for BP self-management |
| Number of Participants Who Report Limiting Alcohol as Helpful for BP Self-management at Six Months | Baseline to 6 months | Patient report that activity is helpful for BP self-management |
| Number of Participants Who Report Physical Activity as Helpful for BP Self-management at Six Months | Baseline to 6 months | Patient report that activity is helpful for BP self management |
| Change in Diastolic BP Between Baseline and 12 Months (mm Hg) | Trajectory over 12 months | change in diastolic BP, collected from medical records |
| Number of Participants Who Report Watching Weight as Helpful for BP Self-management at Six Months | Baseline to 6 months | Patient report that activity is helpful for BP self management |
| Number of Participants Identifying Clinic Visits as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Identifying Cost of Care or Medications as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Increasing Physical Activity as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Lifestyle Changes as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Measuring BP as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Phone Visits as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Scheduling Visits as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting Time Away From Work as BP Care Burden at Six Months | Baseline to 6 months | Patient report that burden is a problem |
| Number of Participants Reporting High Confidence in Knowing BP Target Numbers at Six Months | Baseline to 6 months | Patient reported very or extremely confident in this aspect of BP management |
| Number of Participants Reporting High Confidence in Measuring BP at Home at Six Months | Baseline to 6 months | Patient reported very or extremely confident in this aspect of BP management |
| Number of Participants Reporting High Confidence in Taking BP Medications at Six Months | Baseline to 6 months | Patient reported very or extremely confident in this aspect of BP management |
| Number of Participants With Statin Addition at 12 Months | Baseline to 12 months | New statin medication current at 12 months |
| Number of Participants Who Report Reducing Stress as Helpful for BP Self-management at Six Months | Baseline to 6 months | Patient report that activity is helpful for BP self management |
Countries
United States
Participant flow
Recruitment details
Participants were screened and enrolled during primary care encounters at eligible and randomized primary care clinics in a large integrated health system. Patients were enrolled between November 15, 2017 and April 15, 2019.
Pre-assignment details
Among 57 primary care clinics screened for eligibility, 36 were excluded (16 no MTM; 20 not using automated BP monitor) and 21 were randomized (17 individual clinics plus 4 clinics as 2 co-located pairs). Among 69,480 patients screened in primary care encounters, 3,071 met all inclusion criteria and were enrolled in the study and received care according to the clinic-randomized treatment arm.
Participants by arm
| Arm | Count |
|---|---|
| Best Practice Clinic-Based Care Patients with uncontrolled hypertension who receive primary care in clinics assigned to the Best Practice Clinic-Based Care intervention.
Best Practice Clinic-Based Care: Relies primarily on the physician-medical assistant dyad and face-to-face visits to promote:
1. Improved recognition of uncontrolled BP at primary care encounters,
2. Therapeutic action to address uncontrolled BP at primary care encounters,
3. Reliable follow-up visits to re-assess uncontrolled BP every 2-4 weeks. | 1,648 |
| Telehealth Care Patients with uncontrolled hypertension who receive primary care in clinics assigned to the Telehealth Care intervention.
Telehealth Care: All elements of Clinic-Based Care are performed, plus a telemonitoring and pharmacist case management program is offered, specifically:
1. Referral to care by MTM pharmacist or Nurse Practitioner and receiving a home blood pressure telemonitoring device
2. Systematic home BP telemonitoring with data transmitted into patient medical record
3. Systematic home-based care by pharmacist or nurse practitioner via telephone and/or secure email | 1,423 |
| Total | 3,071 |
Baseline characteristics
| Characteristic | Best Practice Clinic-Based Care | Total | Telehealth Care |
|---|---|---|---|
| Age, Continuous | 58.3 years STANDARD_DEVIATION 14.2 | 60.2 years STANDARD_DEVIATION 14.4 | 62.4 years STANDARD_DEVIATION 14.2 |
| Annual Income $20,000 to $49,999 | 258 Participants | 443 Participants | 185 Participants |
| Annual Income $50,000 to $99,999 | 231 Participants | 469 Participants | 238 Participants |
| Annual Income Greater than or equal to $100,000 | 145 Participants | 262 Participants | 117 Participants |
| Annual Income Less than $20,000 | 164 Participants | 307 Participants | 143 Participants |
| Body Mass Index (BMI) greater than or equal to 30 | 987 Participants | 1730 Participants | 743 Participants |
| Cardiovascular disease | 247 Participants | 512 Participants | 265 Participants |
| Diabetes | 407 Participants | 773 Participants | 366 Participants |
| Diastolic Blood Pressure (DBP) | 93.1 mm Hg STANDARD_DEVIATION 13.8 | 91.7 mm Hg STANDARD_DEVIATION 13.9 | 90.0 mm Hg STANDARD_DEVIATION 13.8 |
| Employment Full-time | 351 Participants | 582 Participants | 231 Participants |
| Employment Otherwise not working for pay | 154 Participants | 290 Participants | 136 Participants |
| Employment Part-time | 71 Participants | 139 Participants | 68 Participants |
| Employment Retired | 332 Participants | 682 Participants | 350 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 46 Participants | 60 Participants | 14 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1585 Participants | 2971 Participants | 1386 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 17 Participants | 40 Participants | 23 Participants |
| Highest education level >4-year college degree | 106 Participants | 218 Participants | 112 Participants |
| Highest education level 4-year college degree | 171 Participants | 308 Participants | 137 Participants |
| Highest education level High school, GED, or less | 316 Participants | 563 Participants | 247 Participants |
| Highest education level Some college or technical school | 315 Participants | 599 Participants | 284 Participants |
| Number of anti-hypertensive medication classes | 1.7 anti-hypertensive medication classes STANDARD_DEVIATION 1.1 | 1.7 anti-hypertensive medication classes STANDARD_DEVIATION 1.1 | 1.7 anti-hypertensive medication classes STANDARD_DEVIATION 1.2 |
| Race (NIH/OMB) American Indian or Alaska Native | 15 Participants | 19 Participants | 4 Participants |
| Race (NIH/OMB) Asian | 92 Participants | 213 Participants | 121 Participants |
| Race (NIH/OMB) Black or African American | 329 Participants | 594 Participants | 265 Participants |
| Race (NIH/OMB) More than one race | 8 Participants | 15 Participants | 7 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 59 Participants | 95 Participants | 36 Participants |
| Race (NIH/OMB) White | 1144 Participants | 2132 Participants | 988 Participants |
| Sex: Female, Male Female | 834 Participants | 1639 Participants | 805 Participants |
| Sex: Female, Male Male | 814 Participants | 1432 Participants | 618 Participants |
| Systolic Blood Pressure (SBP) | 157.4 mm Hg STANDARD_DEVIATION 15.4 | 158.0 mm Hg STANDARD_DEVIATION 15.3 | 158.8 mm Hg STANDARD_DEVIATION 15.2 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 42 / 1,648 | 43 / 1,423 |
| other Total, other adverse events | 597 / 1,648 | 567 / 1,422 |
| serious Total, serious adverse events | 29 / 1,646 | 34 / 1,422 |
Outcome results
Primary
Change in Systolic Blood Pressure Between Baseline and 12 Months (mm Hg)
Change in systolic BP, collected from medical records
Time frame: Trajectory over 12 months
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Best Practice Clinic-Based Care | Change in Systolic Blood Pressure Between Baseline and 12 Months (mm Hg) | -17.97 mm Hg |
| Telehealth Care | Change in Systolic Blood Pressure Between Baseline and 12 Months (mm Hg) | -18.72 mm Hg |
p-value: 0.4595% CI: [-2.84, 1.33]planned contrast
Secondary
Change in Diastolic BP Between Baseline and 12 Months (mm Hg)
change in diastolic BP, collected from medical records
Time frame: Trajectory over 12 months
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Best Practice Clinic-Based Care | Change in Diastolic BP Between Baseline and 12 Months (mm Hg) | -9.98 mm Hg |
| Telehealth Care | Change in Diastolic BP Between Baseline and 12 Months (mm Hg) | -9.70 mm Hg |
p-value: 0.6495% CI: [-0.95, 1.51]planned contrast
Secondary
Number of Participants Identifying Clinic Visits as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Identifying Clinic Visits as BP Care Burden at Six Months | 196 Participants |
| Telehealth Care | Number of Participants Identifying Clinic Visits as BP Care Burden at Six Months | 149 Participants |
p-value: 0.0895% CI: [0.68, 1.03]Mixed Models Analysis
Secondary
Number of Participants Identifying Cost of Care or Medications as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Identifying Cost of Care or Medications as BP Care Burden at Six Months | 188 Participants |
| Telehealth Care | Number of Participants Identifying Cost of Care or Medications as BP Care Burden at Six Months | 134 Participants |
p-value: 0.3295% CI: [0.73, 1.11]Mixed Models Analysis
Secondary
Number of Participants Reporting Cough as a Side Effect of Antihypertensive Medications at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Cough as a Side Effect of Antihypertensive Medications at Six Months | 202 Participants |
| Telehealth Care | Number of Participants Reporting Cough as a Side Effect of Antihypertensive Medications at Six Months | 212 Participants |
p-value: 0.0895% CI: [0.98, 1.4]Mixed Models Analysis
Secondary
Number of Participants Reporting Dizziness as a Side Effect of Antihypertensive Medication at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Dizziness as a Side Effect of Antihypertensive Medication at Six Months | 247 Participants |
| Telehealth Care | Number of Participants Reporting Dizziness as a Side Effect of Antihypertensive Medication at Six Months | 232 Participants |
p-value: 0.1895% CI: [0.95, 1.29]Mixed Models Analysis
Secondary
Number of Participants Reporting Frequent Urination as a Side Effect of Antihypertensive Medication at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Frequent Urination as a Side Effect of Antihypertensive Medication at Six Months | 331 Participants |
| Telehealth Care | Number of Participants Reporting Frequent Urination as a Side Effect of Antihypertensive Medication at Six Months | 293 Participants |
p-value: 0.7795% CI: [0.87, 1.11]Mixed Models Analysis
Secondary
Number of Participants Reporting High Confidence in Keeping BP Below Target at Six Months
Patient reported very or extremely confident in this aspect of BP management.
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting High Confidence in Keeping BP Below Target at Six Months | 242 Participants |
| Telehealth Care | Number of Participants Reporting High Confidence in Keeping BP Below Target at Six Months | 252 Participants |
p-value: 0.8395% CI: [0.83, 1.25]Mixed Models Analysis
Secondary
Number of Participants Reporting High Confidence in Knowing BP Target Numbers at Six Months
Patient reported very or extremely confident in this aspect of BP management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting High Confidence in Knowing BP Target Numbers at Six Months | 437 Participants |
| Telehealth Care | Number of Participants Reporting High Confidence in Knowing BP Target Numbers at Six Months | 465 Participants |
p-value: 0.4195% CI: [0.95, 1.13]Mixed Models Analysis
Secondary
Number of Participants Reporting High Confidence in Measuring BP at Home at Six Months
Patient reported very or extremely confident in this aspect of BP management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting High Confidence in Measuring BP at Home at Six Months | 376 Participants |
| Telehealth Care | Number of Participants Reporting High Confidence in Measuring BP at Home at Six Months | 412 Participants |
p-value: 0.495% CI: [0.94, 1.16]Mixed Models Analysis
Secondary
Number of Participants Reporting High Confidence in Reporting Contacting Care Team at Six Months Confidence in Managing Blood Pressure: Contact Care Team
Patient reported very or extremely confident in this aspect of BP management.
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting High Confidence in Reporting Contacting Care Team at Six Months Confidence in Managing Blood Pressure: Contact Care Team | 481 Participants |
| Telehealth Care | Number of Participants Reporting High Confidence in Reporting Contacting Care Team at Six Months Confidence in Managing Blood Pressure: Contact Care Team | 467 Participants |
p-value: 0.6595% CI: [0.94, 1.1]Mixed Models Analysis
Secondary
Number of Participants Reporting High Confidence in Taking BP Medications at Six Months
Patient reported very or extremely confident in this aspect of BP management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting High Confidence in Taking BP Medications at Six Months | 564 Participants |
| Telehealth Care | Number of Participants Reporting High Confidence in Taking BP Medications at Six Months | 532 Participants |
p-value: 0.7495% CI: [0.95, 1.07]Mixed Models Analysis
Secondary
Number of Participants Reporting Increasing Physical Activity as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Increasing Physical Activity as BP Care Burden at Six Months | 236 Participants |
| Telehealth Care | Number of Participants Reporting Increasing Physical Activity as BP Care Burden at Six Months | 242 Participants |
p-value: 0.0995% CI: [0.98, 1.33]Mixed Models Analysis
Secondary
Number of Participants Reporting Leg/Foot Swelling as a Side Effect of Antihypertensive Medication at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Leg/Foot Swelling as a Side Effect of Antihypertensive Medication at Six Months | 247 Participants |
| Telehealth Care | Number of Participants Reporting Leg/Foot Swelling as a Side Effect of Antihypertensive Medication at Six Months | 208 Participants |
p-value: 0.3295% CI: [0.8, 1.08]Mixed Models Analysis
Secondary
Number of Participants Reporting Lifestyle Changes as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Lifestyle Changes as BP Care Burden at Six Months | 251 Participants |
| Telehealth Care | Number of Participants Reporting Lifestyle Changes as BP Care Burden at Six Months | 192 Participants |
p-value: 0.7795% CI: [0.83, 1.16]Mixed Models Analysis
Secondary
Number of Participants Reporting Measuring BP as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Measuring BP as BP Care Burden at Six Months | 158 Participants |
| Telehealth Care | Number of Participants Reporting Measuring BP as BP Care Burden at Six Months | 164 Participants |
p-value: 0.0995% CI: [0.97, 1.5]Mixed Models Analysis
Secondary
Number of Participants Reporting Phone Visits as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Phone Visits as BP Care Burden at Six Months | 94 Participants |
| Telehealth Care | Number of Participants Reporting Phone Visits as BP Care Burden at Six Months | 66 Participants |
p-value: 0.0295% CI: [0.45, 0.92]Mixed Models Analysis
Secondary
Number of Participants Reporting Scheduling Visits as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Scheduling Visits as BP Care Burden at Six Months | 186 Participants |
| Telehealth Care | Number of Participants Reporting Scheduling Visits as BP Care Burden at Six Months | 127 Participants |
p-value: 0.00695% CI: [0.55, 0.89]Mixed Models Analysis
Secondary
Number of Participants Reporting Sexual Symptoms as a Side Effect of Antihypertensive Medication at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Sexual Symptoms as a Side Effect of Antihypertensive Medication at Six Months | 174 Participants |
| Telehealth Care | Number of Participants Reporting Sexual Symptoms as a Side Effect of Antihypertensive Medication at Six Months | 132 Participants |
p-value: 0.6295% CI: [0.76, 1.19]Mixed Models Analysis
Secondary
Number of Participants Reporting Time Away From Work as BP Care Burden at Six Months
Patient report that burden is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Time Away From Work as BP Care Burden at Six Months | 159 Participants |
| Telehealth Care | Number of Participants Reporting Time Away From Work as BP Care Burden at Six Months | 92 Participants |
p-value: 0.0695% CI: [0.6, 1.01]Mixed Models Analysis
Secondary
Number of Participants Reporting Tiredness as a Side Effect of Antihypertensive Medication at Six Months
Patient report that side effect is a problem
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Reporting Tiredness as a Side Effect of Antihypertensive Medication at Six Months | 437 Participants |
| Telehealth Care | Number of Participants Reporting Tiredness as a Side Effect of Antihypertensive Medication at Six Months | 376 Participants |
p-value: 0.8795% CI: [0.91, 1.08]Mixed Models Analysis
Secondary
Number of Participants Who Are Current Smokers at Twelve Months
Current smoker at 12 months
Time frame: Baseline to 12 months
Population: The numbers of participants analyzed represent the number of participants with smoking status available in the EHR
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Are Current Smokers at Twelve Months | 273 Participants |
| Telehealth Care | Number of Participants Who Are Current Smokers at Twelve Months | 199 Participants |
p-value: 0.7395% CI: [0.95, 1.07]Mixed Models Analysis
Secondary
Number of Participants Who Report Decreasing Salt as Helpful for BP Self-management at Six Months
Patient report that activity is helpful for BP self-management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report Decreasing Salt as Helpful for BP Self-management at Six Months | 274 Participants |
| Telehealth Care | Number of Participants Who Report Decreasing Salt as Helpful for BP Self-management at Six Months | 242 Participants |
p-value: 0.5195% CI: [0.82, 1.11]Mixed Models Analysis
Secondary
Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months.
Patient rating of 9-10 vs. 0-8 on a scale of 0 (low satisfaction) to 10 (high satisfaction). Developed from a scale used by Green, et al (2008). Citation: Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D,Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008;299:2857-2867. doi:10.1001/jama.299.24.2857
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months. | 205 Participants |
| Telehealth Care | Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months. | 241 Participants |
p-value: 0.0395% CI: [1.02, 1.52]Mixed Models Analysis
Secondary
Number of Participants Who Reporting Monitoring BP at Least 2 Times Per Week at Six Months Follow-up
Patient report of monitoring BP at least 2 times per week
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Reporting Monitoring BP at Least 2 Times Per Week at Six Months Follow-up | 189 Participants |
| Telehealth Care | Number of Participants Who Reporting Monitoring BP at Least 2 Times Per Week at Six Months Follow-up | 265 Participants |
p-value: <0.00195% CI: [1.27, 1.85]Mixed Models Analysis
Secondary
Number of Participants Who Report Limiting Alcohol as Helpful for BP Self-management at Six Months
Patient report that activity is helpful for BP self-management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report Limiting Alcohol as Helpful for BP Self-management at Six Months | 147 Participants |
| Telehealth Care | Number of Participants Who Report Limiting Alcohol as Helpful for BP Self-management at Six Months | 138 Participants |
p-value: 0.4195% CI: [0.87, 1.37]Mixed Models Analysis
Secondary
Number of Participants Who Report Physical Activity as Helpful for BP Self-management at Six Months
Patient report that activity is helpful for BP self management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report Physical Activity as Helpful for BP Self-management at Six Months | 291 Participants |
| Telehealth Care | Number of Participants Who Report Physical Activity as Helpful for BP Self-management at Six Months | 256 Participants |
p-value: 0.1895% CI: [0.77, 1.06]Mixed Models Analysis
Secondary
Number of Participants Who Report Reducing Stress as Helpful for BP Self-management at Six Months
Patient report that activity is helpful for BP self management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report Reducing Stress as Helpful for BP Self-management at Six Months | 278 Participants |
| Telehealth Care | Number of Participants Who Report Reducing Stress as Helpful for BP Self-management at Six Months | 243 Participants |
p-value: 0.3195% CI: [0.78, 1.09]Mixed Models Analysis
Secondary
Number of Participants Who Report Watching Weight as Helpful for BP Self-management at Six Months
Patient report that activity is helpful for BP self management
Time frame: Baseline to 6 months
Population: The numbers of participants analyzed represent the number of survey respondents who answered the specific survey item.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants Who Report Watching Weight as Helpful for BP Self-management at Six Months | 290 Participants |
| Telehealth Care | Number of Participants Who Report Watching Weight as Helpful for BP Self-management at Six Months | 249 Participants |
p-value: 0.5695% CI: [0.89, 1.22]Mixed Models Analysis
Secondary
Number of Participants With Statin Addition at 12 Months
New statin medication current at 12 months
Time frame: Baseline to 12 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Best Practice Clinic-Based Care | Number of Participants With Statin Addition at 12 Months | 162 Participants |
| Telehealth Care | Number of Participants With Statin Addition at 12 Months | 151 Participants |
p-value: 0.7195% CI: [0.81, 1.37]Mixed Models Analysis