Home telemonitoring, when combined with pharmacist case management, can help to improve high blood pressure management for patients with the chronic condition, according to research published this week in the Journal of the American Medical Association.
For the study, researchers--led by Karen Margolis, M.D., of the Bloomington, Minn.-based HealthPartners Research Foundation--examined 450 adults with uncontrolled blood pressure. Interventions lasted 12 months, and postintervention follow-up lasted for six months. Patients were required to transmit six BP measurements per week via a home monitor while also meeting with a pharmacist over the phone for one hour every two weeks.
During the first six months of the intervention, the phone conversations--in which pharmacists discussed lifestyle changes and medication adherence with patients--took place every two weeks during until BP had been sustained for six weeks, at which point, the frequency was lowered to monthly. For the latter six months, pharmacist phone calls took place every two months.
Following the postintervention follow-up, roughly 72 percent of patients in the telemonitoring intervention group were able to control their blood pressure, compared with 57 percent of patients who did the same via usual care.
"Our results show that compared with usual primary care, home BP telemonitoring with pharmacist management resulted in large improvements in BP control and substantial decreases in BP during the 12 months," the researchers wrote. "Compared with usual care patients, telemonitoring intervention patients had greater antihypertensive medication intensification and better self-reported adherence to antihypertensive medication and sodium restriction. The intervention also improved some aspects of patient satisfaction to have an acceptable level of safety."
Margolis and her colleagues presented early results involved with their research at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions in Atlanta in May 2012.
"Home BP monitoring, in which patients regularly measure their BP in nonclinical settings, addresses several limitations of traditional office-based BP management," said David Magid, M.D. of Kaiser Permanente's Colorado Institute for Health Research and Beverly Green, M.D., of the Group Health Research Institute at the University of Washington in Seattle in a commentary about the research, also published in JAMA. "Home monitoring enables more frequent measurements in settings familiar to the patient, reducing misclassification due to white-coat or masked hypertension and prompting more timely action to address elevated BP."