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Methods Papers

Hypertension Telemanagement in Blacks

Joseph Finkelstein, MD, PhD and Eunme Cha, MPH

From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, Md.

Correspondence to Joseph Finkelstein, MD, PhD, Director, Chronic Disease Informatics Program, Johns Hopkins Medical Institutions, 2024 E Monument St, Room 2-615, Baltimore, MD 21205. E-mail jfinkel9{at}jhmi.edu

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.

Key Words: hypertension • telemedicine • self care

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