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Technology-Supported Apprenticeship in the Management of Hypertension: A Randomized Controlled Trial

Objective: To compare technology-supported apprenticeship in hypertension management with a successful coaching model at Massachusetts General Hospital.

 

Methods: A randomized controlled trial was conducted. Adult patients with uncontrolled essential hypertension (average blood pressure (BP) 148/87 mm Hg) were recruited in a staggered fashion for a 12-week study period. Intervention subjects received apprenticeship support from a nurse health coach through the CollaboRhythm application on a tablet computer. Patients self-tracked medication adherence and blood pressure (via wireless device) and the coach helped them to continuously progress through lifestyle change and medication adjustment using integrated messaging. Control subjects received support from the same coach but through traditional channels of office visits, phone calls, and e-mail.

Results: 42 of 44 subjects completed the study. Intervention subjects achieved a greater decrease in systolic BP at 12 weeks than control subjects (26.3 mm Hg vs. 16.0 mm Hg, P = 0.009). A greater percentage of intervention subjects achieved goal BP ≤ 130/80 mm Hg (75.0% vs. 31.8%, P = 0.003) and 100% of them achieved goal BP ≤ 140/90 mmHg. They also rated the experience higher, although this finding was not statistically significant (8.9 vs. 7.6, P = 0.12). There was a trend toward increased cost for intervention subjects ($67.50 vs. $53.41, P = 0.15), but the projected cost is much less than standard care ($248/patient/year).

 

Conclusion: This study provides encouraging evidence that technology-supported apprenticeship can improve the outcomes, cost, and experience of care in managing hypertension.