Department of Veterans Affairs Health Services Research and Development Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City, Iowa 52246, USA.
Telemed J E Health. 2011 May;17(4):254-61. doi: 10.1089/tmj.2010.0176. Epub 2011 Apr 10.
Increased emphasis is being placed on the critical need to control hypertension (HTN) in patients with diabetes.
The objective of this study was to evaluate the efficacy of a nurse-managed home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN.
A single-center, randomized, controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used.
Primary outcomes were hemoglobin A1c and systolic blood pressure (SBP); secondary outcome was adherence.
Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group, but 6 months after the intervention was withdrawn, the intervention groups were comparable with the control group. For SBP, the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months. Adherence improved over time for all groups, but there were no differences among the three groups.
Subjects had relatively good baseline control for A1c and SBP; minorities and women were underrepresented.
Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention. Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness.
人们越来越重视控制糖尿病患者高血压（HTN）的迫切需求。
本研究旨在评估护士管理的家庭远程健康干预对改善共患糖尿病和 HTN 的退伍军人结局的疗效。
采用单中心、随机、对照临床试验设计，比较两种远程监测强度水平和常规护理对接受初级保健治疗的 2 型糖尿病和 HTN 患者的影响。
主要结局为糖化血红蛋白（A1c）和收缩压（SBP）；次要结局为依从性。
与对照组相比，干预组在 6 个月的干预期间 A1c 降低，但在干预停止 6 个月后，干预组与对照组相当。对于 SBP，高强度组与其他组相比，6 个月时 SBP 显著降低，这种模式在 12 个月时仍保持不变。所有组的依从性随时间推移而改善，但三组之间无差异。
研究对象的 A1c 和 SBP 基线控制相对较好；少数民族和女性代表性不足。
家庭远程健康为早期发现需要干预的关键临床症状提供了一种创新和实用的方法。通过护士进行持续的教育和建议传输以及密切监测，可以改善共患慢性病患者的临床结局。
