Controlling Hypertension in Native American and Other Populations

NCT ID: NCT03135405

Last Updated: 2019-05-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

295 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-11

Study Completion Date

2019-02-28

Brief Summary

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The study evaluates the use of automated motivational messages, visit reminders, and medication reminders (using interactive voice response technology or text messages) to improve blood pressure control among adults with hypertension that receive their care at the First Nations Community Healthsource clinic in Albuquerque, New Mexico. Half of the participants will receive usual care, while the other half will receive the automated calls or text messages and have the option to receive home blood pressure monitors and/or designate a care partner who will also receive messages. Participants will be followed for 12 months.

Detailed Description

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American Indians and Alaskan Natives (AI/ANs) face pervasive health disparities in comparison to other racial and ethnic groups in the United States. Treatment of hypertension is a pillar of cardiovascular disease prevention. Hypertension is the most common chronic health condition in the U.S. Uncontrolled hypertension increases the risk of acute myocardial infarction, stroke, kidney failure, and congestive heart failure. Hypertension rates are high, levels of control are low, and disparities in care are evident in AI/AN populations.

This study will take place at First Nations Community Healthsource (FNCH) in Albuquerque, New Mexico. FNCH provides primary medical care to urban AI/AN and other socially disadvantaged residents of the Albuquerque, New Mexico area. Approximately 40% of FNCH clients are AI/AN; Diné (Navajo) is the most common tribal affiliation. Many other clients served by FNCH are undocumented immigrants. Housing insecurity and homelessness are common.

This study will use a FNCH hypertension registry to identify all clients with hypertension (regardless of race or ethnicity). From this group, the study will recruit 512 clients, and randomize the participants without stratification to receive automated messages using an interactive voice recognition and text message intervention or to continue in usual care. Consistent with the principles of pragmatic randomized clinical trials, the study has few exclusion criteria in order to maximize inclusion of clients and generalizability of findings. Potentially eligible clients will be contacted by letter and phone. Those who express interest will complete a baseline visit where they provide informed consent, complete a baseline survey, and have blood pressure measured. The participants will then be randomized either to the intervention or usual care arms. Individuals randomized to the intervention arm will receive: reminders of upcoming appointments at FNCH; requests to reschedule missed appointments; reminders to refill medications; and weekly motivational messages to encourage self-care, appointment keeping, and medication-taking for hypertension. These participants will be offered a home blood pressure monitor and trained to use it if they accept, and will be asked if they wish to nominate a care partner to also receive notices of upcoming and missed appointments. In additional to their usual visits at FNCH, all participants will complete research visits with our study coordinators at 6 and 12 months, where they will again have BP measured and complete brief surveys.

Conditions

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Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Usual care

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Group Type EXPERIMENTAL

Automated messages

Intervention Type BEHAVIORAL

Automated motivational messages and visit and medication reminders will be provided via interactive voice response calls or text messages.

Home BP monitors

Intervention Type BEHAVIORAL

Participants will have the option of receiving home blood pressure monitors.

Care partner reminders

Intervention Type BEHAVIORAL

Participants will have the option of designating a care partner who will also receive automated reminder calls or text messages.

Interventions

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Automated messages

Automated motivational messages and visit and medication reminders will be provided via interactive voice response calls or text messages.

Intervention Type BEHAVIORAL

Home BP monitors

Participants will have the option of receiving home blood pressure monitors.

Intervention Type BEHAVIORAL

Care partner reminders

Participants will have the option of designating a care partner who will also receive automated reminder calls or text messages.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* At least two prior visits to First Nations Community Healthsource with blood pressure measurements, with at least one visit in the 24 months prior
* Hypertension
* Between ages 21-79

Exclusion Criteria

* Another preferred site of primary care
* Significant impairment of vision and hearing
* Life-limiting illness
* Renal dialysis
* Receipt of home health care, hospice services or residence in a nursing home
* Dementia
* Pregnancy
* Current incarceration
* Homeless
* No land line or cellular phone access
Minimum Eligible Age

21 Years

Maximum Eligible Age

79 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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American Heart Association

OTHER

Sponsor Role collaborator

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

Kaiser Permanente

OTHER

Sponsor Role lead

Responsible Party

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Emily Schroeder

Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Emily B Schroeder, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Kaiser Permanente

Locations

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First National Community Healthsource

Albuquerque, New Mexico, United States

Site Status

Countries

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United States

References

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Schroeder EB, Moore KR, Manson SM, Baldwin MA, Goodrich GK, Malone AS, Pieper LE, Xu S, Fort MP, Son-Stone L, Johnson D, Steiner JF. A randomized clinical trial of an interactive voice response and text message intervention for individuals with hypertension. J Clin Hypertens (Greenwich). 2020 Jul;22(7):1228-1238. doi: 10.1111/jch.13909. Epub 2020 Jun 9.

Reference Type DERIVED
PMID: 32516486 (View on PubMed)

Schroeder EB, Moore K, Manson SM, Baldwin MA, Goodrich GK, Malone AS, Pieper LE, Xu S, Fort MM, Johnson D, Son-Stone L, Steiner JF. An Interactive Voice Response and Text Message Intervention to Improve Blood Pressure Control Among Individuals With Hypertension Receiving Care at an Urban Indian Health Organization: Protocol and Baseline Characteristics of a Pragmatic Randomized Controlled Trial. JMIR Res Protoc. 2019 Apr 2;8(4):e11794. doi: 10.2196/11794.

Reference Type DERIVED
PMID: 30938688 (View on PubMed)

Other Identifiers

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2P30DK092923

Identifier Type: NIH

Identifier Source: secondary_id

View Link

K23DK099237

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CO-16-2400

Identifier Type: -

Identifier Source: org_study_id

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