基于自动短信的项目改善基层医疗患者血压控制不佳状况：一项随机临床试验
Automated Text Message-Based Program to Improve Uncontrolled Blood Pressure in Primary Care Patients: A Randomized Clinical Trial.
作者信息
Bressman Eric, Profka Klea, Norton Laurie, Clark Kayla, Mahraj Katy, Walker Zakiya, Reid-Bey Leslie, Girard Anthony, Rareshide Charles, Xu Lin, Zhu Jingsan, Putt Mary, Volpp Kevin G, Morgan Anna U
机构信息
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Gen Intern Med. 2025 May;40(6):1248-1254. doi: 10.1007/s11606-024-09225-4. Epub 2024 Dec 4.
BACKGROUND
Suboptimal control of BP is common, although safe and effective treatments are widely available. Conventional management relies on office visits, but this can be an inefficient path to medication optimization.
OBJECTIVE
To assess the effectiveness of an intensive, 6-month remote BP management program among patients with uncontrolled hypertension.
DESIGN
A two-arm randomized clinical trial which ran from January to July 2023 at two primary care practices with an in-clinic BP measurement at the end of the intervention.
PARTICIPANTS
Established adult patients (ages 21-80) of study practices with uncontrolled hypertension (two measurements > 140/90 in the prior 12 months) and an active prescription for at least one anti-hypertensive agent.
INTERVENTION
Participants received automated text messages prompting them to check their BP weekly for 6 months. An RN and APP monitored BP data entered by the participant. The automated platform escalated any out-of-normal range readings or needs to the program staff.
MAIN MEASURES
The primary outcome was change in SBP from baseline to the end-of-study measurement. Enrollment and engagement measures were collected for the intervention arm.
KEY RESULTS
Of the 300 participants, the mean (SD) age was 63 (± 12.2) years; 133 (44.3%) were male and 167 (55.7%) were female; 154 (51.5%) self-identified as Black and 120 (40.1%) White; and 119 (39.7%) were insured by Medicare and 41 (13.7%) by Medicaid. The change in SBP at 6 months among those who completed the end-of-study measurement was - 14.66 mmHg (95% CI - 19.95, - 9.36) in the intervention arm and - 10.87 mmHg (95% CI - 18.04, - 3.69) in the control arm (p = 0.39). Within the intervention arm, 97 participants (64.7%) completed all enrollment steps, and these participants submitted BPs 72.8% of the weeks. Participants in the intervention arm had a greater number of medication changes (0.81 vs 0.57 in the control arm, p = 0.01) over the study period.
CONCLUSIONS
In this randomized clinical trial of a 6-month automated text messaging program, there was no significant difference in the change in SBP among participants in each arm.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05571410.
背景
尽管有广泛可用的安全有效治疗方法，但血压控制不佳的情况很常见。传统管理依赖于门诊就诊，但这可能是药物优化的低效途径。
目的
评估一项为期6个月的强化远程血压管理计划对高血压控制不佳患者的有效性。
设计
一项双臂随机临床试验，于2023年1月至7月在两家初级保健机构进行，干预结束时进行门诊血压测量。
参与者
研究机构中确诊的成年患者（年龄21 - 80岁），患有未控制的高血压（过去12个月内两次测量血压>140/90）且至少有一种抗高血压药物的有效处方。
干预措施
参与者收到自动短信，提示他们连续6个月每周测量血压。注册护士（RN）和高级实践护师（APP）监测参与者输入的血压数据。自动平台将任何超出正常范围的读数或需求上报给项目工作人员。
主要测量指标
主要结局是收缩压（SBP）从基线到研究结束时测量值的变化。收集干预组的入组和参与度指标。
关键结果
300名参与者中，平均（标准差）年龄为63（±12.2）岁；男性133名（44.3%），女性167名（55.7%）；154名（51.5%）自我认定为黑人，120名（40.1%）为白人；119名（39.7%）由医疗保险承保，41名（13.7%）由医疗补助承保。在完成研究结束时测量的参与者中，干预组6个月时SBP的变化为-14.66 mmHg（95%置信区间-19.95，-9.36），对照组为-10.87 mmHg（95%置信区间-18.04，-3.69）（p = 0.39）。在干预组中，97名参与者（64.7%）完成了所有入组步骤，这些参与者在72.8%的周数内提交了血压数据。在研究期间，干预组参与者的药物调整次数更多（干预组为0.81次，对照组为0.57次，p = 0.01）。
结论
在这项为期6个月的自动短信计划的随机临床试验中，每组参与者的SBP变化无显著差异。
试验注册
ClinicalTrials.gov标识符：NCT05571410。
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