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Telehealth & Remote Measurement Technologies to Improve Medication Adherence in Hypertension (HTN MedTrack)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Boston Medical Center
ClinicalTrials.gov Identifier:
NCT01439256
First received: August 30, 2011
Last updated: April 5, 2013
Last verified: April 2013
  Purpose

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. The investigators also seek to further understand the efficacy and mechanisms of intervention targeting both patients and physicians. The study aims at facilitating tertiary prevention of cardiovascular, cerebrovascular, and renovascular diseases by promoting better blood pressure to reduce overall risk.


Condition Intervention
Hypertension
Device: Electronic pill tray direct reporting to physician (Telephone-Linked Care: Hypertension 2- Electronic Pill Tray)
Behavioral: Patient self reporting of medication adherence

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: Telehealth & Remote Measurement Technologies to Improve Medication Adherence in Hypertension

Resource links provided by NLM:


Further study details as provided by Boston Medical Center:

Primary Outcome Measures:
  • Blood Pressure [ Time Frame: Up to 1 year ] [ Designated as safety issue: No ]
    This study will follow the Joint National Committee's (JNC) recommendations for blood pressure. JNC recommends that blood pressure should be reduced to less than 140/90 mm Hg. In this study the investigators will consider blood pressure as a continuous variable and as a binary categorical variable, following the guidelines of the JNC on blood pressure evaluation.


Secondary Outcome Measures:
  • Medication Adherence [ Time Frame: Up to 1 year ] [ Designated as safety issue: Yes ]

    Adherence at or over 80% is considered overall medication adherence.

    It is likely that some patient subjects in the intervention group who increase their medication regimen adherence will experience a reduction in their blood pressure. In rare instances, this reduction might lead to a syncopal episode or other medical complications due to hypotension. The investigators expect that such events will be exceedingly rare, yet, possible. TLC is designed to monitor for occurrence of hypotension, and if it occurs, TLC will generate an alert to the patient-subjects' responsible physicians.



Enrollment: 207
Study Start Date: September 2011
Study Completion Date: April 2013
Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Electronic Pill Tray Direct Report
This study arm is evaluating whether providing physicians with medication adherence information and current blood pressure (BP) values, coupled with appropriate advice on promoting adherence and/or intensifying the medication regimen helps them make appropriate clinical decisions to improve their patients' BP control. This arm relies on medication adherence data that comes from an electronic pill tray. Patient subjects in this group are provided with home blood pressure monitors. The monitor automatically stores the data, including dates/times of the measurements and the subject transmits the data to the TLC system. This group will have medication taking behavior reported directly to the patient's physician.
Device: Electronic pill tray direct reporting to physician (Telephone-Linked Care: Hypertension 2- Electronic Pill Tray)
This is an electronic monitoring system designed to compile the dosing history of subjects prescribed oral medications. The system is comprised of a standard plastic pill tray with daily compartments that contain micro-electronic circuits that register times when the closure is opened and when it is closed. This information is sent to the patient's physician.
Other Name: TLC HTN 2- Electronic Pill Tray
Experimental: Hypertension Self Report
This arm is evaluating whether providing physicians with medication adherence information and current blood pressure (BP) values, coupled with appropriate advice on promoting adherence and/or intensifying the medication regimen, helps them make appropriate clinical decisions to improve their patients' BP control. Patient subjects in this group are provided with home blood pressure monitors. The monitor automatically stores the data, including dates/times of the measurements and the subjects transmit the data to the TLC system. Patients in this arm use the electronic pill trays. However, the physicians must rely on the patient subject's self-reported medication adherence.
Behavioral: Patient self reporting of medication adherence
Subjects will use an electronic pill tray, though this information is NOT sent to the patient's physician. Instead, the physician must rely on the patient's self-reporting of his/her medication adherence.
Other Name: TLC HTN 2-Self Report
No Intervention: Usual Care
In this arm, patients receive usual care from their physicians. Usual care is defined as receiving regular care from the physician and no additional care or intervention from the study. Subjects in this group are also provided with electronic pill trays. These readings are taken at the 6 month visit.

Detailed Description:

The study will utilize new technologies to improve medication adherence in an unobtrusive way and employ electronic transmission of medication-taking behaviors. Additionally, the system will periodically analyze such information and deliver the processed information to patients' prescribing physicians in general medical practices. 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.

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. Patients reported their blood pressure to TLC 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.

Electronic pill trays for oral, solid medications (e.g., tablets and capsules) will be used 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.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

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.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01439256

Locations
United States, Massachusetts
Boston Medical Center
Boston, Massachusetts, United States, 02118
Sponsors and Collaborators
Boston Medical Center
Investigators
Principal Investigator: Ramesh Farzanfar, PhD Boston Medical Center
  More Information