Home blood pressure telemonitoring with a pharmacist leads to much better blood pressure control over a 12-month period, when compared with usual care, researchers from HealthPartners Institute for Education and Research, Minneapolis, reported in
The authors added that the improved blood pressure continued for six months after the intervention had stopped.
Hypertension (high blood pressure) is the most common reason patients with chronic conditions visit their primary care doctor. Approximately 30% of American adults have high blood pressure, a condition with an estimated economic health burden exceeding $50 billion per year.
As background information, the authors wrote “Decades of research have shown that treatment of hypertension prevents cardiovascular events; and many well-tolerated, effective, and inexpensive drugs are readily available. Although BP control has improved during the past 2 decades, it is controlled to recommended levels in only about half of U.S. adults with hypertension.
“Several recent studies suggest that a combined intervention of telemedicine with nurse- or pharmacist-led care may be effective for improving hypertension management, but none included post-intervention follow-up. Also, previous studies excluded patients with comorbidities [other illnesses] and more severe hypertension.”
Karen L. Margolis, M.D., M.P.H., and team set out to determine how effective home BP (blood pressure) telemonitoring with pharmacist case management might be. They needed a nationally-representative sample population with a range of comorbidity and hypertension severity typically found in primary care clinics across the country.
The team conducted a randomized clinical trial involving 450 adults recruited from the electronic records of 16 primary care practices in Minneapolis-St. Paul. The participants, all with uncontrolled hypertension, were followed up at 6 to 12 months after the intervention started, and then 6 months after it stopped.
The researchers randomly selected 16 clinics into two groups:
- Telemonitoring intervention group – eight clinics gave 228 intervention patients home BP telemonitors which transmitted blood pressure data to pharmacists who adjusted their anti-hypertensive therapy accordingly.
- Usual care group – eight clinics provided 222 patients with usual care.
Primary measured outcome was what percentage of patients achieved systolic BP of less than 140 mm Hg and diastolic BP of less than 90 mm Hg – six months after intervention was finished. For patients with chronic kidney disease or diabetes the measured primary outcomes were <130/80 mm Hg. Secondary outcomes included:
- Patient satisfaction
- BP control six months after intervention stopped
- Change in BP
The researchers managed to follow up 380 patients at 12 months after the start of intervention and 6 months after it stopped (two visits).
Below are some highlighted results from the study:
- 57.2% in the telemonitoring intervention group had ‘controlled BP’ at both visits
- 30% in the usual care group had controlled BP at both visits
- 71.8% in the telemonitoring intervention group had controlled BP at 18 months
- 57.1% in the usual care group had controlled BP at 18 months
- Of the 362 participants who attended all three clinic visits (6, 12 and 18 months), 50.9% in the intervention group had controlled BP compared to 21.3% in the usual care group
The investigators wrote:
“Self-efficacy questions indicated telemonitoring intervention patients were substantially more confident than usual care patients that they could communicate with their health care team, integrate home BP monitoring in their weekly routine, follow their medication regimen, and keep their BP under control. Telemonitoring intervention patients self-reported adding less salt to food than usual care patients at all time points, but other lifestyle factors did not differ.
If these results are found to be cost-effective and durable during an even longer period, it should spur wider testing and dissemination of similar alternative models of care for managing hypertension and other chronic conditions.”
David J. Magid, M.D., M.P.H., of the Kaiser Permanente Colorado Institute for Health Research, Denver, and Beverly B. Green, M.D., M.P.H., of the Group Health Research Institute, Seattle, in an Accompanying Editorial explained that the current reimbursement system as well as performance measurement will need to be changed before home BP monitoring can become part of standard primary care practice.
The authors wrote:
“First, to minimize patient barriers to participation, health insurers must follow the lead of the Veterans Health Administration and provide benefit coverage for BP monitors.
Second, clinicians and health care organizations must be reimbursed for services related to home BP monitoring, which are currently not covered by Medicare and many other payers; otherwise, clinicians in fee-for-service systems are unlikely to voluntarily give up reimbursements for hypertension-related office visits.
Third, home BP measurements must be included in quality assurance assessments of hypertension care. Currently, the National Committee for Quality Assurance performance measure for BP control considers only BP measurements made in the clinic, even though home BP measurements correlate as well or better with 24-hour ambulatory BP measurements and are more predictive of cardiovascular outcomes than clinic measures.”
Below is a JAMA Video – “Patients Better Control High Blood Pressure With At Home Monitoring And Working With a Pharmacist”
In May 2012, Dr. Margolis and team reported their mid-trial findings at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2012.
Telemonitoring with doctor effectively lowers blood pressure – researchers from the University of Edinburgh, Scotland, reported in BMJ (British Medical Journal) that a portable self-monitoring system which records and sends blood pressure readings directly to the doctor in real-time significantly improves patient health.
Written by Christian Nordqvist