Optimizing blood pressure control by an Information Communication Technology-supported case management (PIA study): study protocol for a cluster-randomized controlled trial of a delegation model for general practices

Background: Longitudinal hypertension control prevents heart attacks, strokes, and other cardiovascular diseases. However, 49% of patients in German family medicine practices do not reach blood pressure (BP) targets (< 140/90 mmHg). Drawing on successful international approaches, the PIA study introduces the PIA information and communication technology system (PIA-ICT) for hypertension management in primary care. The PIA-ICT comprises the PIA-App for patients and the PIA practice management center for practices. Case management includes electronic communication with patients, recall, and stepwise medication adjustments following guidelines. The system supports a physician-supervised delegation model to practice assistants. General practitioners are qualified by eLearning. Patients learn how to obtain reliable BP readings, which they communicate to the practice using the PIA-App. Methods: The effectiveness of the PIA-Intervention is evaluated in a cluster-randomized study with 60 practices, 120 practice assistants, and 1020 patients. Patients in the intervention group receive the PIA-Intervention; the control group receives usual care. The primary outcome is the BP control rate (BP < 140/90 mmHg) after 12 months. Using a mixed methods approach, secondary outcomes address the acceptance on behalf of physicians, practice assistants, and patients. This includes an evaluation of the delegation model. Discussion: It is hypothesized that the PIA-Intervention will improve the quality of BP care. Perspectively, it may constitute an important health service model for primary care in Germany.