Grant: SPOR Networks in Chronic Disease - LOI

The goal of the ACTIVE PATIENT Network is to bring patients into a co-management relationship with their doctors, or clinical teams, to reduce the long-term health problems associated with higher levels of blood pressure (hypertension) and blood sugar (diabetes). Patients with hypertension and diabetes have an important daily challenge in terms of regular physical activity, healthy eating habits, and taking their medications consistently. They may require more support and guidance than is possible with only a couple of clinic visits each year. One of the key strategies to be evaluated by the Network will be the use of special monitors ('biosensors') that measure blood pressure, blood glucose, and physical activity by patients and sending this information to a 'health coach' electronically, between clinic visits. Vendor provided software tools will capture and manage this information and alert the health coach to new information. The health coach could then send advice and support to the patient, electronically or by phone, based on algorithms and/or discussion with health care team members. This would be a sort of '21st century medical kit.' By the end of five years, the Network will have sufficient data, as well as a wealth of patient-specific feedback to determine if such a system could result in better blood pressure control in hypertension, better blood sugar control in diabetes, and better eating and physical activity habits. Patients will be continuously involved in the design of experimental strategies. We will then test these strategies through clinical trials, to see if they actually result in more efficient, patient-oriented healthcare in Canada for both youth and adults.