Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial

  • Karen L. Margolis
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Anna R. Bergdall
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • A. Lauren Crain
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Meghan M. JaKa
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Jeffrey P. Anderson
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Leif I. Solberg
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • JoAnn Sperl-Hillen
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • MarySue Beran
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Beverly B. Green
    Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.).
  • Patricia Haugen
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Christine K. Norton
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Amy J. Kodet
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Rashmi Sharma
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Deepika Appana
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Nicole K. Trower
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Pamala A. Pawloski
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Daniel J. Rehrauer
    HealthPartners, Minneapolis, MN (D.J.R., M.L.S., R.A.W.).
  • Maria L. Simmons
    HealthPartners, Minneapolis, MN (D.J.R., M.L.S., R.A.W.).
  • Zeke J. McKinney
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Thomas E. Kottke
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Jeanette Y. Ziegenfuss
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).
  • Rae Ann Williams
    HealthPartners, Minneapolis, MN (D.J.R., M.L.S., R.A.W.).
  • Patrick J. O’Connor
    HealthPartners Institute, Minneapolis, MN (K.L.M., A.R.B., A.L.C., M.M.J., J.P.A., L.I.S., J.S.-H., M.B., P.H., C.K.N., A.J.K., R.S., D.A., N.K.T., P.A.P., Z.J.M., T.E.K., J.Y.Z., P.J.O.).

抄録

<jats:sec> <jats:title>Background:</jats:title> <jats:p>A team approach is one of the most effective ways to lower blood pressure (BP) in uncontrolled hypertension, but different models for organizing team-based care have not been compared directly.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A pragmatic, cluster-randomized trial compared 2 interventions in adult patients with moderately severe hypertension (BP≥150/95 mm Hg): (1) clinic-based care using best practices and face-to-face visits with physicians and medical assistants; and (2) telehealth care using best practices and adding home BP telemonitoring with home-based care coordinated by a clinical pharmacist or nurse practitioner. The primary outcome was change in systolic BP over 12 months. Secondary outcomes were change in patient-reported outcomes over 6 months.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Participants (N=3071 in 21 primary care clinics) were on average 60 years old, 47% male, and 19% Black. Protocol-specified follow-up within 6 weeks was 32% in clinic-based care and 27% in telehealth care. BP decreased significantly during 12 months of follow-up in both groups, from 157/92 to 139/82 mm Hg in clinic-based care patients (adjusted mean difference −18/−10 mm Hg) and 157/91 to 139/81 mm Hg in telehealth care patients (adjusted mean difference −19/−10 mm Hg), with no significant difference in systolic BP change between groups (−0.8 mm Hg [95% CI, −2.84 to 1.32]). Telehealth care patients were significantly more likely than clinic-based care patients to report frequent home BP measurement, rate their BP care highly, and report that BP care visits were convenient.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension.</jats:p> </jats:sec> <jats:sec> <jats:title>Registration:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT02996565. </jats:p> </jats:sec>

収録刊行物

  • Hypertension

    Hypertension 79 (12), 2708-2720, 2022-12

    Ovid Technologies (Wolters Kluwer Health)

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