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精准测量、快速行动、与患者合作(MAP)改善医疗资源不足患者的高血压控制:医疗协调协会和美国医学协会高血压控制项目试点研究结果。

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results.

机构信息

Department of Family Medicine, Greenville Health System, Greenville, SC, USA.

University of South Carolina School of Medicine-Greenville, Greenville, SC, USA.

出版信息

J Clin Hypertens (Greenwich). 2018 Jan;20(1):79-87. doi: 10.1111/jch.13141. Epub 2018 Jan 5.

Abstract

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence-based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6-month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM-907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self-monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.

摘要

测量准确、快速行动并与患者合作(MAP)是一项基于证据的方案,旨在改善服务不足患者(49.9% Medicaid 和 50.2%黑人)的高血压控制。在干预前一年接受过高血压治疗且在 6 个月干预期间至少有一次就诊的患者(N=714)被纳入研究。如果初始就诊时血压(BP;标准无液气压计)≥140/≥90mmHg,则使用欧姆龙 HEM-907XL 重复测量三遍并平均(测量准确)未就诊的自动诊室 BP。当自动诊室 BP≥140/≥90mmHg 时,快速行动包括评估治疗惰性的降压药物强化。与患者合作包括血压自我监测、减少药物负担和尽量降低药物成本,这是通过每次治疗强化的收缩压变化来评估的。在基线和最后一次研究访视之间,血压控制到<140/<90mmHg 的比例从 61.2%增加到 89.9%(P<.0001)。MAP 迅速显著改善了医疗服务不足患者的高血压控制,这主要是由于准确测量血压和与患者合作。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48d1/8031245/66c917782f79/JCH-20-79-g001.jpg

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