远程医疗在卒中后护理中的应用试点研究：在服务欠缺地区开展家庭血压远程监测的随机试验。
Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting.
机构信息
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, NY (I.A.N., K.S., S.E.T., O.A.W., M.S.V.E.).
Department of Biostatistics, Mailman School of Public Health, Columbia University, NY (Y.K.C.).
出版信息
Stroke. 2022 Dec;53(12):3538-3547. doi: 10.1161/STROKEAHA.122.041020. Epub 2022 Oct 31.
BACKGROUND
Hypertension is the most important modifiable stroke risk factor, but blood pressure (BP) remains poorly controlled after stroke, especially among Black and Hispanic patients. We tested the feasibility of TASC (Telehealth After Stroke Care), a post-acute stroke care model integrating nurse-supported home BP telemonitoring, tailored infographics, and multidisciplinary team video visits.
METHODS
Acute stroke patients with hypertension were randomized at discharge to usual care or usual care with TASC. Usual care patients received video visits with primary care and stroke. TASC included a tablet and monitor to wirelessly transmit BP data to the electronic health record, with telenursing support, tailored infographics to explain BP readings, and pharmacist visits. Outcomes assessment was blinded. Feasibility outcomes included recruitment, randomization, adherence, and retention. Systolic BP from baseline to 3 months after discharge was evaluated using generalized linear modeling.
RESULTS
Fifty patients (64±14 years; 36% women' 44% Hispanic, 32% Black, 54% ≤high school education, 30% private insurance), and 75% of all eligible were enrolled over 6.3 months. Baseline systolic BP was similar in both (TASC n=25, 140±19 mm Hg; usual care n=25, 142±19 mm Hg). At 3 months, adherence to video visits (91% versus 75%, =0.14) and retention (84% versus 64%, =0.11) were higher with TASC. Home systolic BP declined by 16±19 mm Hg from baseline in TASC and increased by 3±24 mm Hg in usual care (=0.01). Among Black patients, systolic BP control (<130 mm Hg) improved from 40% to 100% with TASC versus 14% to 29%, and among Hispanic patients, from 23% to 62% with TASC, versus 33% to 17% in usual care.
CONCLUSIONS
Enhancing post-acute stroke care with home BP telemonitoring is feasible to improve hypertension in an underserved setting and should be tested in a definitive randomized clinical trial.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04640519.
背景
高血压是最重要的可改变的中风危险因素，但中风后血压（BP）控制仍然很差，尤其是在黑人和西班牙裔患者中。我们测试了 TASC（中风后远程护理）的可行性，这是一种急性后期中风护理模式，整合了护士支持的家庭 BP 远程监测、定制信息图和多学科团队视频访问。
方法
患有高血压的急性中风患者在出院时被随机分配到常规护理或常规护理加 TASC。常规护理患者接受初级保健和中风的视频访问。TASC 包括一个平板电脑和监视器，用于将 BP 数据无线传输到电子健康记录，同时提供远程护理支持、解释 BP 读数的定制信息图和药剂师访问。结果评估是盲法的。可行性结果包括招募、随机化、依从性和保留率。使用广义线性模型评估从基线到出院后 3 个月的收缩压。
结果
共有 50 名患者（64±14 岁；36%为女性，44%为西班牙裔，32%为黑人，54%为高中学历以下，30%为私人保险），在 6.3 个月内招募了所有符合条件的患者的 75%。两组基线收缩压相似（TASC 组 n=25，140±19mmHg；常规护理组 n=25，142±19mmHg）。在 3 个月时，TASC 的视频访问依从性（91%对 75%，=0.14）和保留率（84%对 64%，=0.11）更高。TASC 组的家庭收缩压从基线下降了 16±19mmHg，而常规护理组则上升了 3±24mmHg（=0.01）。在黑人患者中，TASC 组的收缩压控制（<130mmHg）从 40%提高到 100%，而常规护理组从 14%提高到 29%；在西班牙裔患者中，TASC 组从 23%提高到 62%，而常规护理组从 33%提高到 17%。
结论
通过家庭 BP 远程监测增强急性后期中风护理是可行的，可以改善服务不足人群的高血压状况，应该在一项明确的随机临床试验中进行测试。
登记
网址：https://www.
临床试验
gov；唯一标识符：NCT04640519.
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