Telehealth & Remote Measurement Technologies to Improve Medication Adherence in Hypertension
Telehealth & Remote Measurement Technologies to Improve Medication Adherence in Hypertension
This study focuses on an important patient behavior, medication-taking, and important
 physician behaviors: promoting medication regimen adherence in patients and appropriately
 modifying therapy when existing therapy results in inadequate therapeutic effect. The study
 will also explore the caregivers' (clinicians) behavior after relevant information about
 their patients' medication adherence and blood pressure control has been provided to them.
 The investigators focus on behavior change for patients and physicians and seek to change
 their behaviors to improve the health care delivery process and outcomes. The study aims at
 facilitating tertiary prevention of cardiovascular, cerebrovascular, and reno-vascular
 diseases by promoting better blood pressure control.
The study will use state-of-the-art technologies, including two systems that use a
 telephone-based platform called TLC (Telephone-Linked Care). The two TLC applications have
 been developed for patients with hypertension (TLC-HTN) as well as patients who have
 difficulty adhering to their medication regimen (TLC-MED). The investigators will also use
 state-of-the-art medication monitoring technology (electronic pill trays) that monitor
 patients' medication-taking behaviors in the intervention and control arms.

 The TLC-HTN system was designed for patients with hypertension (HTN) whose blood pressure
 (BP) was out of control and who were given a home blood pressure monitor. All study subjects
 (intervention and control) were asked to take their blood pressure at home on a weekly basis.
 The system gave them feedback on how the reported blood pressure compared to their previous
 blood pressure values and goals set by their physician. Using self-reported medication-taking
 behavior provided to the TLC-MED module, TLC-HTN gave the patient additional feedback that
 linked their adherence to their blood pressure control. At the end of each weekly TLC-HTN
 conversation, the system sent a report to the patient's physician that displayed recent and
 previous blood pressure values, identified trends, compared the blood pressures to the
 physician's goal for the patient and accepted norms, and displayed anti-hypertensive
 medication use/adherence levels in a similar manner so that the physician could relate
 adherence to blood pressure control.

 TLC-Medication Adherence (TLC-MED): TLC-MED is an additional module that is added to the TLC
 chronic disease systems including TLC-HTN, with the purpose of promoting medication regimen
 adherence. In each TLC conversation, TLC-MED will assess the patient's adherence to the
 medications prescribed for that disease. In this project, the investigators will evaluate two
 versions of TLC-MED, one which uses an electronic medication event monitoring system to
 determine medication taking, and the other which uses patient self-report information for
 determining the same information. The investigators will compare both the self-report method
 of obtaining medication-taking behavior/adherence and the electronic pill trays to usual
 care.

 Commercially available electronic pill trays for oral, solid medications (e.g., tablets and
 capsules) will be used by both arms to assess patient medication adherence along with subject
 self-report of medication-taking. There are a number of methods for conducting medication
 event monitoring for solid medications. The investigators will use electronic pill trays,
 consisting of a pillbox containing 28 cups arranged in a 7x4 matrix. Each cup has a sensor
 that registers when the cup is opened.
Inclusion Criteria for Patients:

 -  A patient at one of the two primary care practices of General Internal Medicine, or in
 Family Medicine, Boston Medical Center (BMC), whose Primary Care Physician (PCP) is
 participating in the study.

 -  A diagnosis of hypertension on the active problem list.

 -  BP > 140/90 (over 130/80 if diabetic) for two or more consecutive visits (any clinic
 in the hospital, not limited to PCP but excluding Emergency Department(ED)) over the
 prior 12 months.

 -  Having been prescribed at least one anti-hypertension medication (currently listed on
 the list of prescribed medications).

 -  Has at least one appointment scheduled with his/her PCP within the next six months.

 -  Age 18 and over.

 -  Is planning to continue his/her primary care at Boston Medical Center for at least the
 next 7 months.

 -  Is willing and able to use the electronic medication tray unassisted to take the
 study-selected medication for the next seven months.

 Inclusion Criteria for Physicians:

 -  Be a primary care physician in General Internal Medicine, BMC, or be a primary care
 physician in Family Medicine, BMC, or be a resident in General Internal Medicine, BMC.

 -  Have a patient who is eligible and participates in the study.

 Exclusion Criteria for Patients:

 -  Planning to move from the Boston area during the study period.

 -  No home telephone or touch tone service.

 -  Cannot use a telephone unassisted.

 -  Is not willing to receive calls at his/her phone during the study period.

 -  Does not understand conversational English over the telephone.

 -  Currently enrolled in the TLC-MultiDisease study.

 -  Is planning to use another electronic medication tray or bottle (such as Medication
 Events Monitoring Systems (MEMS) to take the study-selected medication for the next
 seven months.

 Exclusion Criteria for Physicians:

 -  Not having a patient or patients in the study.