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.).
Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.).
Hypertension. 2022 Dec;79(12):2708-2720. doi: 10.1161/HYPERTENSIONAHA.122.19816. Epub 2022 Oct 25.
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.
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.
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.
Telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension.
URL: https://www.
gov; Unique identifier: NCT02996565.
团队方法是降低未控制高血压患者血压（BP）的最有效方法之一，但尚未直接比较组织团队护理的不同模式。
一项实用的、集群随机试验比较了 2 种干预措施在中度严重高血压（BP≥150/95mmHg）的成年患者中的效果：（1）诊所为基础的护理，使用最佳实践和医生和医疗助理的面对面访问；（2）远程医疗护理，使用最佳实践，并通过临床药剂师或执业护士协调的家庭护理增加家庭血压远程监测。主要结局是 12 个月时收缩压的变化。次要结局是 6 个月时患者报告结局的变化。
参与者（21 个初级保健诊所中的 3071 名）平均年龄为 60 岁，47%为男性，19%为黑人。诊所为基础的护理组在 6 周内按方案规定进行随访的比例为 32%，远程医疗护理组为 27%。两组患者在 12 个月的随访期间，血压均显著下降，从诊所为基础护理组的 157/92 降至 139/82mmHg（调整后的平均差值为-18/-10mmHg），从远程医疗护理组的 157/91 降至 139/81mmHg（调整后的平均差值为-19/-10mmHg），两组间收缩压变化无显著差异（-0.8mmHg[95%CI，-2.84 至 1.32]）。与诊所为基础护理组相比，远程医疗护理组患者更有可能频繁测量家庭血压、高度评价其血压护理，并报告血压护理就诊方便。
包括扩展团队护理的远程医疗是改善高血压患者以患者为中心护理的一种有效且安全的替代诊所为基础的护理方法。
