Medication Adherence in Poorly Controlled Hypertensives

Project Background and Goals:

This project is a collaboration between CDN and Mount Sinai School of Medicine, Division of Integrative and Behavioral Cardiology (MSSM).  The project will evaluate the effectiveness of a two-step intervention that includes the use of a home self blood pressure tele-monitoring device with automatic tele-feedback, combined with telephone-based nurse case management, (experimental) vs. usual care (control) on blood pressure control and medication adherence.  A total of 480 poorly controlled patients who also demonstrate poor medication adherence will be recruited from 12 Community/Migrant Health Centers in New York and New Jersey for participation in the project.

During the first phase of the project, participants will be randomized to receive either usual care or the home self blood pressure (BP) tele-monitor.  Patients who are provided the home self blood pressure tele-monitor will receive immediate feedback of their BP via digital read out. In addition, patients will receive external feedback via a voice mail message informing him/her whether he/she has reached the blood pressure target level.  The patients' providers will also receive feedback via the home blood pressure tele-monitor reports, which are faxed to their offices.

Participants who remain uncontrolled after three months using the home self BP tele-monitor will be further randomized either to remain on home self BP tele-monitoring alone or to receive a combination of the home self BP tele-monitoring and telephone based nurse case management. The nurse case management will be provided via monthly scheduled telephone appointments with the participants.  These phone calls will address barriers to medication adherence, review of side effects, provide positive reinforcement and problem solving strategies, as well as feedback on progress toward reaching optimal BP.