Abstract：
Hypertension control remains poor. Multiple barriers at the level of patients, providers, and health systems interfere with implementation of hypertension guidelines and effective lowering of BP. Some strategies such as self-measured blood pressure (SMBP) and remote management by pharmacists are safe and effectively lower BP but have not been effectively implemented. In this study, we combine such evidence-based strategies to build a remote hypertension program and test its effectiveness and implementation in large health systems. This randomized, controlled, pragmatic type I hybrid implementation effectiveness trial will examine the virtual collaborative care clinic (vCCC), a hypertension program that integrates automated patient identification, SMBP, remote BP monitoring by trained health system pharmacists, and frequent patient-provider communication. We will randomize 1000 patients with uncontrolled hypertension from two large health systems in a 1:1 ratio to either vCCC or control (usual care with education) groups for a 2-year intervention. Outcome measures including BP measurements, cognitive function, and a symptom checklist will be completed during study visits. Other outcome measures of cardiovascular events, mortality, and health care utilization will be assessed using Medicare data. For the primary outcome of proportion achieving BP control (defined as systolic BP < 130 mmHg) in the two groups, we will use a generalized linear mixed model analysis. Implementation outcomes include acceptability and feasibility of the program. This study will guide implementation of a hypertension program within large health systems to effectively lower BP.
摘要：
高血压控制仍然很差。患者层面的多重障碍，提供者,和卫生系统会干扰高血压指南的实施和血压的有效降低。自我测量血压（SMBP）和药剂师远程管理等策略是安全有效地降低BP，但尚未有效实施。在这项研究中,我们结合这些循证策略,构建远程高血压项目,并在大型卫生系统中测试其有效性和实施情况.这个随机的，控制,务实的I型混合实施有效性试验将检查虚拟协作护理诊所(VCCC)，一个整合了自动患者识别的高血压项目，SMBP,由训练有素的卫生系统药剂师进行远程血压监测，和频繁的患者-提供者沟通。我们将以1：1的比例从两个大型卫生系统中随机分配1000例未控制的高血压患者，以vCCC或对照组（常规护理和教育）进行为期2年的干预。包括BP测量在内的结果测量，认知功能,并在研究访视期间完成症状检查表。心血管事件的其他结局指标，死亡率,医疗保健利用率将使用医疗保险数据进行评估。对于两组中达到血压控制(定义为收缩压<130mmHg)的比例的主要结果,我们将使用广义线性混合模型分析。实施成果包括方案的可接受性和可行性。这项研究将指导大型卫生系统中高血压计划的实施，以有效降低BP。
