Hypertensive patients who participated in a 1-year pharmacist telemonitoring program were more likely to have their blood pressure under control than those who received usual care.
A combination of telemonitoring and pharmacist case management may help control blood pressure in hypertensive patients better than usual care, according to the results of a study
published in the July 9, 2013 edition of the Journal of the American Medical Association
. Patients who worked with pharmacists continued to have improved blood pressure control 6 months after the intervention ended.
The cluster randomized trial enrolled 450 adults with uncontrolled blood pressure as recorded in electronic medical records across 16 primary care clinics in an integrated health system in the Minneapolis-St. Paul metropolitan area. Participants were assigned to receive usual care or pharmacist telemonitoring intervention for 1 year. Patients in the intervention group were given a home blood pressure monitor that transmitted data to a secure website monitored by pharmacists. At the beginning of the intervention, pharmacists met with patients to review their medical history, give them general information about hypertension, and train them on use of the blood pressure telemonitoring system.
Patients in the intervention group were instructed to send at least 6 blood pressure measurements to the pharmacist each week. During the first 6 months of the intervention, patients and pharmacists spoke on the phone every 2 weeks. When patients had successfully controlled their blood pressure for 6 weeks in a row, the frequency of the phone calls was reduced to once a month. During the second half of the study, phone call frequency was reduced to once every 2 months. Pharmacists counseled patients on lifestyle changes and medication adherence during the calls. In addition, pharmacists made changes to patients’ medications using an algorithm based on national guidelines. Participants in both the pharmacist intervention and usual care groups were asked to visit a research clinic for follow up after 6 months of intervention, at the end of the 12-month intervention period, and 6 months after the intervention ended.
After 6 months of intervention, blood pressure was controlled in 71.8% of patients in the telemonitoring group and 45.2% of those in the usual care group. Six months after the intervention ended, 71.8% of patients in the telemonitoring group still had controlled blood pressure, compared with 57.1% of those in the usual care group. Among the 362 patients who attended all 3 follow-up visits, 50.9% of those in the telemonitoring group had controlled blood pressure at all visits, compared with just 21.3% of usual care patients.
In addition, systolic blood pressure dropped more on average for those in the telemonitoring group than those in the usual care group at all 3 follow-up visits. Self-reported adherence to hypertension medications increased among telemonitoring patients and decreased among usual care patients within the first 6 months of the study, but did not significantly differ between the 2 groups at 12 or 18 months. Patients in the telemonitoring group also indicated that they felt more confident than usual care patients in monitoring their blood pressure and communicating with their health care team.
The telemonitoring intervention was estimated to cost approximately $1350 per patient, and the researchers plan to investigate the program’s cost-effectiveness in future studies, accounting for long-term cost savings gained from preventing cardiovascular events and hospitalizations.