Self-monitoring can help patients improve their blood pressure, but the effects tend not to last unless doctors also provide support services, according to a study published at the Annals of Internal Medicine.
The researchers reviewed 52 previous clinical studies in a project funded by the Agency for Healthcare Research and Quality. They compared the results for self-monitoring with no additional services beyond regular doctor visits, usual care, and self-monitoring along with web-based connections to their clinics, counseling and other services.
While self-monitoring by itself did produce a small reduction in blood pressure at six months, compared with usual care, it wasn't evident at 12 months. By comparison, those who received ongoing counseling and other services achieved a reduction of 3.4 points to 8.9 points after a year, compared with usual care.
The problem is that is that doctors aren't reimbursed for the extra services, The Wall Street Journal points out. To see major benefits, "you would actually need the additional staff. You would need the infrastructure for transmission of values and have systems in place to act on readings in a responsible way," said lead researcher Katrin Uhlig, a nephrologist at Tufts Medical Center in Boston.
In fact, David Magid, a Colorado-based researcher for Kaiser Permanente, pointed to a financial disincentive for doctors to offer home blood-pressure monitoring.
He lead a research project five years ago in which patients had to write down their readings, then phone or fax them to researchers. He found better results in a more recent project, published at the journal Circulation, in which blood-pressure data was sent automatically to a team of pharmacists, who could recommend medication changes. Over six months, patients' blood pressure at 10 Kaiser clinics declined by an average of 12 points more than a group who underwent usual care.
In a study published at American Heart Journal, researchers reported improvements in blood pressure through a telemedicine system, which they referred to as essentially a behavior-modification program – it reminded patients to measure and monitor their blood pressure twice a week.