TY - JOUR AU - Lewinski, Allison A AU - Patel, Uptal D AU - Diamantidis, Clarissa J AU - Oakes, Megan AU - Baloch, Khaula AU - Crowley, Matthew J AU - Wilson, Jonathan AU - Pendergast, Jane AU - Biola, Holly AU - Boulware, L Ebony AU - Bosworth, Hayden B PY - 2019 DA - 2019/04/09 TI -解决糖尿病和控制不佳的高血压问题:实用的移动健康自我管理干预:远程医疗:心血管疾病:2型糖尿病:易感人群:肾功能不全:专业患者关系:高血压背景:糖尿病和控制不良的高血压患者发生肾脏和心血管不良结局的风险增加。早期识别这些患者并处理可改变的危险因素对于延迟肾脏并发症(如糖尿病肾病)至关重要。移动医疗(mHealth)是一种相对廉价且易于扩展的技术，可以促进以患者为中心的护理并促进自我管理的参与，特别是对社会经济地位较低的患者而言。因此，移动医疗可能是提供自我管理教育和支持的一种具有成本效益的方式。目的:本可行性研究旨在通过识别有不良肾脏结局风险的糖尿病和控制不佳的高血压患者，建立一个人口管理项目，并评估多因素干预来解决药物自我管理问题。我们从美国东南部一个服务不足的多元化县的联邦合格医疗中心(FQHC)招募患者。方法:通过电子病历对患者进行身份识别。纳入标准为年龄在18 - 75岁之间，诊断为2型糖尿病，过去12个月内高血压控制不良(临床平均收缩压[SBP]≥140 mm Hg和/或舒张压[DBP]≥90 mm Hg)，使用手机，能够接收短信和电子邮件。干预包括6个月内由病例管理员每月打电话和每周单向信息短信。 Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. Results: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. Conclusion: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. Trial Registration: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU) SN - 1438-8871 UR - //www.mybigtv.com/2019/4/e12541/ UR - https://doi.org/10.2196/12541 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964439 DO - 10.2196/12541 ID - info:doi/10.2196/12541 ER -