SHCC/MXC PA Program EBM Journal Club Week 1 – Introduction to the Club and Article Analysis
Introduction to the Club! <ul><li>A group of individuals who meet regularly to critically evaluate medical literature </li...
Survey/Questionnaire  <ul><li>Please fill out this quick survey so that we can later evaluate the performance of the club!...
Survey/Questionnaire  <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><...
Survey/Questionnaire  <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><...
Survey/Questionnaire  <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><...
Survey/Questionnaire  <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><...
Survey/Questionnaire  <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><...
Survey/Questionnaire  <ul><li>THANKS FOR TAKING THE SURVEY! </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effec...
Our Selection for this Meeting <ul><li>“ Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacis...
Overview <ul><li>Q: What is the research question asked? </li></ul><ul><li>A: Does a new model of care improve BP control?...
Overview <ul><li>Q: What is the main outcome of interest? </li></ul><ul><li>A: % of pts. w/ controlled BP (<140/90) and ch...
Overview <ul><li>Q: Who are the subjects/participants? </li></ul><ul><li>A: n=778; pts 25-75 y/o with uncontrolled ESSENTI...
PANCE Point! <ul><li>Q: What is essential hypertension? </li></ul><ul><li>A: Essential HTN = no other/secondary cause of H...
Overview <ul><li>Q: What do the authors conclude? </li></ul><ul><li>A: Pharmacist care mgnt delivered thru secure pt web c...
Are the Results Valid?!? <ul><li>Q: Did the experimental and control grps begin the study with a similar prognosis? </li><...
Are the Results Valid?!? <ul><li>Q: Were pts. randomized? </li></ul><ul><li>A:  Yes,   </li></ul><ul><li>Randomized Contro...
Randomized Control Trial (RCT) <ul><ul><li>Entire group was randomized to balance within medical centers (not too many one...
Randomized Control Trial (RCT) Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitor...
Are the Results Valid?!? <ul><li>Q: Was the randomization concealed? </li></ul><ul><li>A:  Yes,   </li></ul><ul><li>Resear...
Are the Results Valid?!? <ul><li>Q: Were pts. analyzed in the grps to which they were randomized? </li></ul><ul><li>A:  Ye...
Are the Results Valid?!? <ul><li>Q: Were pts in the tx and control groups similar with respect to known prognostic factors...
Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Were 5 important groups aware of group alloca...
Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Aside from experimental intervention, were th...
Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Was follow-up complete? </li></ul><ul><li>A: ...
Enough Already!  What are the RESULTS!?! <ul><li>Q: What were the PRIMARY OUTCOMES? </li></ul><ul><li>A: Home BP + Web did...
Enough Already!  What are the RESULTS!?! <ul><li>Q: What were the PRIMARY OUTCOMES? </li></ul><ul><li>A: Systolic BP decre...
What is RELATIVE RISK? <ul><li>RR = P exposed /P unexposed </li></ul><ul><li>Prob of those w/ new tx improving </li></ul><...
Enough Already!  What are the RESULTS!?! <ul><li>Q: What were the SECONDARY OUTCOMES? </li></ul><ul><li>A: Several:  </li>...
Enough Already!  What are the RESULTS!?! <ul><li>Q: What statistical methods are employed? </li></ul><ul><li>A: Linear reg...
Enough Already!  What are the RESULTS!?! <ul><li>Q: Do these results refute the null hypothesis? </li></ul><ul><li>A: Yes....
How Can I Apply the Results to My Future Pt Care? <ul><li>Q: Were the study pts similar to my pts/potential/future pts? </...
What are the WEAKNESSES of this Study? <ul><li>Limited to pts with uncontrolled essential HTN and were required to have co...
What are the STRENGTHS of this Study? <ul><li>RCT </li></ul><ul><li>Care mgmt over the web a novel concept, combining with...
CONCLUSIONS! <ul><li>“ Our findings demonstrate the effectiveness of using home BP monitoring combined with pharmacy care ...
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EBM Journal Club - Intro and Review of Home BP Monitoring Article

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This presentation is an introduction to the EBM Journal Club at MXC and a review of "Effectiveness of Home Blood Pressure
Monitoring, Web Communication, and
Pharmacist Care on Hypertension Control:
A Randomized Controlled Trial.”
Green B, Cook AJ, Ralston JD, et. al.
JAMA. 2008; 299(24): 2857-2867

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EBM Journal Club - Intro and Review of Home BP Monitoring Article

  1. 1. SHCC/MXC PA Program EBM Journal Club Week 1 – Introduction to the Club and Article Analysis
  2. 2. Introduction to the Club! <ul><li>A group of individuals who meet regularly to critically evaluate medical literature </li></ul><ul><li>Long Hx in graduate medical education, earliest reference in mid-1800s </li></ul><ul><li>Three goals: (1) keep up with current lit, (2) impact clinical practice, (3) teach critical reading skills </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  3. 3. Survey/Questionnaire <ul><li>Please fill out this quick survey so that we can later evaluate the performance of the club! </li></ul><ul><li>Possibly present this survey data at conference next spring? Publish??? </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  4. 4. Survey/Questionnaire <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><li>I have prior exposure to/experience with Journal Clubs. </li></ul><ul><ul><li>Strongly Diagree , I have no previous exposure/experience </li></ul></ul><ul><ul><li>Disagree , I have a little experience, not significant (1-2 times) </li></ul></ul><ul><ul><li>Agree , I have some, but not much (3-5 times) </li></ul></ul><ul><ul><li>Strongly Agree , I have much experience (>5 times) </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  5. 5. Survey/Questionnaire <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><li>(2) I currently feel comfortable independently CRITICALLY APPRASING journal articles. </li></ul><ul><ul><li>Strongly Diagree , not comfortable at all. </li></ul></ul><ul><ul><li>Disagree , slightly comfortable, but I need more exposure </li></ul></ul><ul><ul><li>Agree , comfortable, I need a little guidance but not much </li></ul></ul><ul><ul><li>Strongly Agree , completely comfortable, I understand all aspects of critical appraisal </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  6. 6. Survey/Questionnaire <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><li>(3) I feel that this experience will make me more comfortable critically evaluating journal articles </li></ul><ul><ul><li>Disagree , I don’t think this experience will improve my critical evaluation skills </li></ul></ul><ul><ul><li>Agree , I think this experience will help me to critically evaluate articles </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  7. 7. Survey/Questionnaire <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><li>(4) I feel that journal club is an appropriate use of my time in this program. </li></ul><ul><ul><li>Disagree , I do not believe it is a good use of time </li></ul></ul><ul><ul><li>Agree , it is a good use of time </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  8. 8. Survey/Questionnaire <ul><li>Please read each statement and chose to agree or disagree as you feel TODAY: </li></ul><ul><li>(5) Journal club is my preferred way of learning how to critically evaluate articles. </li></ul><ul><ul><li>Disagree , I think there maybe better ways to learn these skills </li></ul></ul><ul><ul><li>Agree , I feel that this is the best way for me to learn </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  9. 9. Survey/Questionnaire <ul><li>THANKS FOR TAKING THE SURVEY! </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  10. 10. Our Selection for this Meeting <ul><li>“ Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial.” </li></ul><ul><li>Green B, Cook AJ, Ralston JD, et. al. </li></ul><ul><li>JAMA. 2008; 299(24): 2857-2867 </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial . JAMA . 299(24): 2857-2867
  11. 11. Overview <ul><li>Q: What is the research question asked? </li></ul><ul><li>A: Does a new model of care improve BP control? </li></ul><ul><li>A: (More specific) Does a model including MD care, web access and access to pharmacist online improve control in pts age 25-75 with essential hypertension and internet access? </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  12. 12. Overview <ul><li>Q: What is the main outcome of interest? </li></ul><ul><li>A: % of pts. w/ controlled BP (<140/90) and changes in sys & dias BP @ 12 mo. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  13. 13. Overview <ul><li>Q: Who are the subjects/participants? </li></ul><ul><li>A: n=778; pts 25-75 y/o with uncontrolled ESSENTIAL HTN and internet access </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  14. 14. PANCE Point! <ul><li>Q: What is essential hypertension? </li></ul><ul><li>A: Essential HTN = no other/secondary cause of HTN. </li></ul><ul><li>Secondary HTN is a sequella of some other process (e.g., Kidney dz, pheochromocytoma) </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  15. 15. Overview <ul><li>Q: What do the authors conclude? </li></ul><ul><li>A: Pharmacist care mgnt delivered thru secure pt web com improved BP control in pts with HTN </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  16. 16. Are the Results Valid?!? <ul><li>Q: Did the experimental and control grps begin the study with a similar prognosis? </li></ul><ul><li>A: Yes, </li></ul><ul><li>uncontrolled HTN with Rx therapies </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  17. 17. Are the Results Valid?!? <ul><li>Q: Were pts. randomized? </li></ul><ul><li>A: Yes, </li></ul><ul><li>Randomized Control Trial (RCT) </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  18. 18. Randomized Control Trial (RCT) <ul><ul><li>Entire group was randomized to balance within medical centers (not too many one type of pt. at any one) and with reference to baseline systolic BP. ( First Randomization – usual group working with just MD and therapy group) </li></ul></ul><ul><ul><ul><li>Those with high systolic BPs (160-199) were stratified into a separate subgroup  now there are two therapy groups, three grps total. ( Second Randomization ) </li></ul></ul></ul><ul><ul><ul><ul><li>Within these two groups patients were then randomly assigned in blocks to the 3 study groups. (block randomization ensures balance of controls and experimental groups) ( third randomization ) </li></ul></ul></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  19. 19. Randomized Control Trial (RCT) Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867 778 Randomized 520 Randomized to receive active intervention 258 randomized to rec’v usual care 259 Randomized to home + web only 261 randomized to home + web + pharm 246 completed follow up and included in analysis 237 completed follow up and included in analysis 247 completed follow up and included in analysis 520 randomized again after rec’v BP mon and web training
  20. 20. Are the Results Valid?!? <ul><li>Q: Was the randomization concealed? </li></ul><ul><li>A: Yes, </li></ul><ul><li>Research assistants were BLINDED to group assignment. Obviously, pts and clinicians could not be. Analysts were blinded. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  21. 21. Are the Results Valid?!? <ul><li>Q: Were pts. analyzed in the grps to which they were randomized? </li></ul><ul><li>A: Yes, </li></ul><ul><li>They were STRATIFIED BY INTERVENTION GROUP. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  22. 22. Are the Results Valid?!? <ul><li>Q: Were pts in the tx and control groups similar with respect to known prognostic factors? </li></ul><ul><li>A: Yes, </li></ul><ul><li>Except for female sex, and already having a home BP monitor. These were controlled for in primary analyses. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  23. 23. Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Were 5 important groups aware of group allocation? </li></ul><ul><li>A: Yes and No, but not an issue. </li></ul><ul><li>Pts. Aware (obviously), caregivers aware, outcome collectors (rsch assistants) NOT aware, data analysts NOT aware. </li></ul><ul><li>Appropriate BLINDING. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  24. 24. Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Aside from experimental intervention, were the groups treated equally? </li></ul><ul><li>A: Yes. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  25. 25. Did Experimental and Control Groups Maintain a Similar Prognosis? <ul><li>Q: Was follow-up complete? </li></ul><ul><li>A: Yes. </li></ul><ul><li>Attempted for all pts & even if they did not receive assigned intervention or deviated from protocol. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  26. 26. Enough Already! What are the RESULTS!?! <ul><li>Q: What were the PRIMARY OUTCOMES? </li></ul><ul><li>A: Home BP + Web did NOT improve BP vs. usual therapy (did improve Systolic BP). </li></ul><ul><li>+Pharm  25% increase in pts w/ controlled HTN vs. usual // 20% vs. home + web </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  27. 27. Enough Already! What are the RESULTS!?! <ul><li>Q: What were the PRIMARY OUTCOMES? </li></ul><ul><li>A: Systolic BP decreased stepwise across groups. </li></ul><ul><li>Diastolic BP was decr. only in pharm care grp. </li></ul><ul><li>In >160 sys grp with home, web, pharm vs. usual: </li></ul><ul><ul><li>Greater net reduction in sys BP </li></ul></ul><ul><ul><li>“ “ diastolic BP </li></ul></ul><ul><ul><li>And overall improved control </li></ul></ul><ul><ul><ul><li>(RELATIVE RISK, 3.32) </li></ul></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  28. 28. What is RELATIVE RISK? <ul><li>RR = P exposed /P unexposed </li></ul><ul><li>Prob of those w/ new tx improving </li></ul><ul><li>Prob of those w/o new tx improving </li></ul><ul><li>So, those in the >160 grp with home + web + pharm are 3.32 TIMES more likely to improve with the tx vs. usual. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  29. 29. Enough Already! What are the RESULTS!?! <ul><li>Q: What were the SECONDARY OUTCOMES? </li></ul><ul><li>A: Several: </li></ul><ul><li>Home + web has incr in HTN Rx classes vs. usual (more drugs!) </li></ul><ul><li>Home + web + pharm had incr in HTN Rx classes vs both; incr ASA use vs. both </li></ul><ul><li>Lifestyle, BMI, QOL did not change in any group </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  30. 30. Enough Already! What are the RESULTS!?! <ul><li>Q: What statistical methods are employed? </li></ul><ul><li>A: Linear regression models (think: controlling for confounders!) adjusted for baseline outcome measures and characteristics related to outcome. </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  31. 31. Enough Already! What are the RESULTS!?! <ul><li>Q: Do these results refute the null hypothesis? </li></ul><ul><li>A: Yes. The null hypothesis is: </li></ul><ul><li>A new model of care will not improve BP control. </li></ul><ul><li>This is refuted by the results (i.e., the new model does improve control)! </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  32. 32. How Can I Apply the Results to My Future Pt Care? <ul><li>Q: Were the study pts similar to my pts/potential/future pts? </li></ul><ul><li>Q: Were all pt important outcomes considered? </li></ul><ul><li>Q: Are the likely benefits worth the potential harms/cost? </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  33. 33. What are the WEAKNESSES of this Study? <ul><li>Limited to pts with uncontrolled essential HTN and were required to have computers, internet, and email access </li></ul><ul><li>Pts w/o computer access were more likely to be older, a racial/ethnic minority, less education  digital divide </li></ul><ul><li>Pts ineligible with comorbidities (DM, CVD, etc.) </li></ul><ul><ul><li>To keep medication protocols simple </li></ul></ul><ul><li>Pts in home + web grp might have shown similar reductions if sent email reminders </li></ul><ul><li>Will BP control be maintained long-term? </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  34. 34. What are the STRENGTHS of this Study? <ul><li>RCT </li></ul><ul><li>Care mgmt over the web a novel concept, combining with EMR trend </li></ul><ul><li>“… an essential element for the transformation of health care is continuous access (24/7) to health care” </li></ul><ul><li>Chronic Care Model applied to HTN </li></ul><ul><ul><li>Has shown improvements in other chronic illnesses </li></ul></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867
  35. 35. CONCLUSIONS! <ul><li>“ Our findings demonstrate the effectiveness of using home BP monitoring combined with pharmacy care over the web to improve BP control for patients with essential hypertension.” </li></ul><ul><li>Do you agree? </li></ul>Green BB, Cook AJ, Ralston JD, et. al. (2008). Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 299(24): 2857-2867

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