Hypertension Clinical Trial
Official title:
Teams Advancing Patient Experience: Strengthening Quality for People Through Health Connectors for Diabetes Management (TAPESTRY-HC-DM): A Feasibility RCT
The TAPESTRY-HC-DM approach is designed to support self-management of chronic disease by strengthening connections between patients and the primary healthcare system through "health connectors" -both volunteers and technology including the TAPESTRY Healthy Lifestyle App and McMaster Personal Health Record (PHR). It will explore whether strengthening primary care connections across patients, providers, and community organizations through TAPESTRY-HC-DM - i.e., the deployment of volunteer health connectors coordinated by a community organization, the use of the TAPESTRY Healthy Lifestyle e-Application by patients, and care coordination processes by the interprofessional primary healthcare team - can increase self-efficacy in managing chronic conditions.
TAP-HC-DM is a feasibility randomized controlled trial (RCT) involving various pieces of
intervention and their interactions to form a complex adaptive system. The purpose of the
trial is to assess the effectiveness of the intervention not only through evaluating patient
outcomes, but also through understanding the process of implementation and its fidelity to
core elements.
The trial will be conducted within the McMaster Family Health Team (MFHT) in Hamilton,
Ontario. The MFHT consists of two sites, with approximately 30,000 patients, as well as 30
family physicians, 70 family medicine residents, 10 nurse practitioners and other healthcare
professionals.
Initial lists of potential participants will be created using an algorithm based on the
inclusion criteria that will be run on the clinics' electronic medical records systems, with
manual chart audits completed afterwards on an as-needed basis. The family physicians will
then be asked to vet this list for further exclusion criteria. Patients from the list will
then be sent a package including an invite letter from their family physician and a consent
form.
Participants who have consented, will receive a welcome call from volunteers who will then
provide detailed description of the program and expectations. The clients will then be
invited to sign up for McMaster Personal Health Record (PHR) and asked to complete the
modules (Diabetes, Hypertension, Sleep, Exercise, Nutrition, Medications, PHR) on the Healthy
Lifestyle app. After completion of the modules, participants will receive a report and
suggested tip sheets based on their responses. Volunteers as health connectors will connect
with clients weekly, providing motivation, education, tech support, and community
connections. The healthcare teams at the clinics will also receive the report and will triage
it in their weekly huddles. Any follow-up recommended by the clinics will be communicated to
volunteers who will then work with clients on the given recommendations, or directly to
patients.
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