A blood pressure control program involving remote monitoring and phone consultation by pharmacist case managers produced promising results.
Telemonitoring by pharmacist case managers appears to be a viable method of improving blood pressure control in patients with hypertension, according to the results of a study
published in the October 2012 edition of the Journal of Clinical Hypertension
. In particular, researchers noted that patients in the telemonitoring group that checked in with pharmacist case managers were particularly compliant with self-monitoring procedures.
The researchers conducted a cluster randomized trial in 16 primary care clinics run by HealthPartners Medical Group, a Minnesota-based health care organization. Eight clinics served as a control population and received physician-led blood pressure care, while participants at the other 8 clinics received pharmacist-managed blood pressure telemonitoring. All participants had at least 2 consecutive elevated blood pressure readings (greater than 140/90 mm Hg) in the year prior to the study, and all participants received check-ups at the research clinics at 6-month intervals during the 18-month study.
Participants in the telemonitoring group received home blood pressure monitors that transmitted readings to pharmacist case managers, who could access them through a secure website. Participants in the telemonitoring group and their pharmacist case managers met once in person during the study and communicated by phone every 2 weeks during the first 6 months of the study or monthly if blood pressure was controlled during the previous 3 phone consultations.
The pharmacist case managers, who had expertise in medication therapy management, were integrated into each clinic’s medical team. In addition, collaborative practice agreements with the clinics allowed pharmacists to see patients and prescribe treatment for selected conditions.
Participants in the telemonitoring group were instructed to measure their blood pressure at least 6 times per week and were encouraged to take 2 or 3 measurements at 1-minute intervals during each measurement session. The data collection system sent auto-alerts to pharmacist case managers in case of very high or very low readings and when patients failed to comply with their measurement schedule.
The researchers included 213 of the 228 participants in the telemonitoring group in their results, excluding those who failed to transmit any blood pressure readings and 1 who did not provide demographic information. The results showed that participants in the telemonitoring group followed the instruction to take at least 6 blood pressure readings per week very well. In fact, they took an average of 31.5 readings per week, with the total most likely elevated due to the instruction to take multiple measurements during each reading session. Participation in phone consultations with the pharmacist case managers was high as well, averaging 91.5% during months 0 through 3 and 86.6% in months 3 through 6. Only 74 participants missed any of their scheduled phone consultations, while 139 took part in all of them.