Srista Manandhar, Sunit Chhetri, Danielle Sutton, Animita C Saha, Suneet Kaur, Josh Brown, Jeff Williamson, Kathryn E Callahan, Justin B Moore, Yhenneko J Taylor, Hayden B Bosworth, Yashashwi Pokharel
{"title":"试点以黑人患者为重点的高血压团队远程医疗护理。","authors":"Srista Manandhar, Sunit Chhetri, Danielle Sutton, Animita C Saha, Suneet Kaur, Josh Brown, Jeff Williamson, Kathryn E Callahan, Justin B Moore, Yhenneko J Taylor, Hayden B Bosworth, Yashashwi Pokharel","doi":"10.1186/s40814-025-01656-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current telemedicine programs to manage hypertension are less effective in Black compared with White patients in the US. Insufficient support for self-care skills and unaddressed social needs may explain the differences. We evaluated feasibility of a team-based telemedicine program using home blood pressure (BP) monitoring (HBPM) guided pharmacotherapy and supporting patients' self-care skills and social needs.</p><p><strong>Methods: </strong>We conducted a single-arm pilot study in two safety-net clinics in North Carolina, enrolling 20 adults with uncontrolled hypertension on stable antihypertensive regimen with smartphone access, and English proficiency. We excluded individuals with conditions impairing home BP monitoring, complex chronic illnesses, or recent acute health events. The 12-week intervention included daily HBPM, HBPM-guided pharmacotherapy, telephone-based self-management support by trained nurses, and social support from community health workers (CHW) and social workers. We evaluated feasibility for recruitment and retention and completion of intervention components, pre-specified as ≥ 70% of expected HBPM (7 times/week/patient) and ≥ 80% self-management calls/patient (8 in clinic 1 and 12 in clinic 2).</p><p><strong>Results: </strong>Among 135 patients approached, 28.9% (n = 39) were eligible. We enrolled 20 patients (17 Black patients, 9 women) and 18 (90%) completed the study. Patients measured their BP an average of 9.4 (SD 8.6) times/week (134.3% of expected) and completed 78.3% of expected calls. We provided social support to 11 patients 19 times including support at home visits by CHWs, mostly for food and medications. There were challenges in supporting other social needs like housing. There was mean (SD) of 1.1 (0.8) medication activation/patient (dose or medication changes), and 8 minor technical issues about HBPM/telemonitoring application use, which were promptly resolved.</p><p><strong>Conclusion: </strong>Our team-based telemedicine hypertension intervention shows feasibility for recruitment, retention, and HBPM, partial feasibility for social support, and almost met feasibility for self-management support. Community informed approaches can further improve program implementation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT05424744, Registered 9 June 2022, https://clinicaltrails.gov/study/NCT05424744 .</p><p><strong>Trial funding: </strong>Department of Cardiovascular Medicine, Wake Forest University School of Medicine.</p>","PeriodicalId":20176,"journal":{"name":"Pilot and Feasibility Studies","volume":"11 1","pages":"95"},"PeriodicalIF":1.6000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232565/pdf/","citationCount":"0","resultStr":"{\"title\":\"Piloting a team-based telemedicine care for hypertension focused on Black patients.\",\"authors\":\"Srista Manandhar, Sunit Chhetri, Danielle Sutton, Animita C Saha, Suneet Kaur, Josh Brown, Jeff Williamson, Kathryn E Callahan, Justin B Moore, Yhenneko J Taylor, Hayden B Bosworth, Yashashwi Pokharel\",\"doi\":\"10.1186/s40814-025-01656-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Current telemedicine programs to manage hypertension are less effective in Black compared with White patients in the US. Insufficient support for self-care skills and unaddressed social needs may explain the differences. We evaluated feasibility of a team-based telemedicine program using home blood pressure (BP) monitoring (HBPM) guided pharmacotherapy and supporting patients' self-care skills and social needs.</p><p><strong>Methods: </strong>We conducted a single-arm pilot study in two safety-net clinics in North Carolina, enrolling 20 adults with uncontrolled hypertension on stable antihypertensive regimen with smartphone access, and English proficiency. We excluded individuals with conditions impairing home BP monitoring, complex chronic illnesses, or recent acute health events. The 12-week intervention included daily HBPM, HBPM-guided pharmacotherapy, telephone-based self-management support by trained nurses, and social support from community health workers (CHW) and social workers. We evaluated feasibility for recruitment and retention and completion of intervention components, pre-specified as ≥ 70% of expected HBPM (7 times/week/patient) and ≥ 80% self-management calls/patient (8 in clinic 1 and 12 in clinic 2).</p><p><strong>Results: </strong>Among 135 patients approached, 28.9% (n = 39) were eligible. We enrolled 20 patients (17 Black patients, 9 women) and 18 (90%) completed the study. Patients measured their BP an average of 9.4 (SD 8.6) times/week (134.3% of expected) and completed 78.3% of expected calls. We provided social support to 11 patients 19 times including support at home visits by CHWs, mostly for food and medications. There were challenges in supporting other social needs like housing. 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Piloting a team-based telemedicine care for hypertension focused on Black patients.
Background: Current telemedicine programs to manage hypertension are less effective in Black compared with White patients in the US. Insufficient support for self-care skills and unaddressed social needs may explain the differences. We evaluated feasibility of a team-based telemedicine program using home blood pressure (BP) monitoring (HBPM) guided pharmacotherapy and supporting patients' self-care skills and social needs.
Methods: We conducted a single-arm pilot study in two safety-net clinics in North Carolina, enrolling 20 adults with uncontrolled hypertension on stable antihypertensive regimen with smartphone access, and English proficiency. We excluded individuals with conditions impairing home BP monitoring, complex chronic illnesses, or recent acute health events. The 12-week intervention included daily HBPM, HBPM-guided pharmacotherapy, telephone-based self-management support by trained nurses, and social support from community health workers (CHW) and social workers. We evaluated feasibility for recruitment and retention and completion of intervention components, pre-specified as ≥ 70% of expected HBPM (7 times/week/patient) and ≥ 80% self-management calls/patient (8 in clinic 1 and 12 in clinic 2).
Results: Among 135 patients approached, 28.9% (n = 39) were eligible. We enrolled 20 patients (17 Black patients, 9 women) and 18 (90%) completed the study. Patients measured their BP an average of 9.4 (SD 8.6) times/week (134.3% of expected) and completed 78.3% of expected calls. We provided social support to 11 patients 19 times including support at home visits by CHWs, mostly for food and medications. There were challenges in supporting other social needs like housing. There was mean (SD) of 1.1 (0.8) medication activation/patient (dose or medication changes), and 8 minor technical issues about HBPM/telemonitoring application use, which were promptly resolved.
Conclusion: Our team-based telemedicine hypertension intervention shows feasibility for recruitment, retention, and HBPM, partial feasibility for social support, and almost met feasibility for self-management support. Community informed approaches can further improve program implementation.
Trial registration: ClinicalTrials.gov, NCT05424744, Registered 9 June 2022, https://clinicaltrails.gov/study/NCT05424744 .
Trial funding: Department of Cardiovascular Medicine, Wake Forest University School of Medicine.
期刊介绍：
Pilot and Feasibility Studies encompasses all aspects of the design, conduct and reporting of pilot and feasibility studies in biomedicine. The journal publishes research articles that are intended to directly influence future clinical trials or large scale observational studies, as well as protocols, commentaries and methodology articles. The journal also ensures that the results of all well-conducted, peer-reviewed, pilot and feasibility studies are published, regardless of outcome or significance of findings. Pilot and feasibility studies are increasingly conducted prior to a full randomized controlled trial. However, these studies often lack clear objectives, many remain unpublished, and there is confusion over the meanings of the words “pilot” and “feasibility”. Pilot and Feasibility Studies provides a forum for discussion around this key aspect of the scientific process, and seeks to ensure that these studies are published, so as to complete the publication thread for clinical research.
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