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Hickam DH (Portland VAMC), Rasmussen KM
(Portland VAMC), Harris CC
(Portland VAMC), Leng M
(Portland VAMC)
Objectives:
Enhanced communication between patients and providers can improve management of chronic diseases. By monitoring disease status at home, treatment plans can be monitored and adjusted in a more timely manner. The objectives of this study were to evaluate the effectiveness and efficiency of a novel electronic tool for home blood pressure (BP) monitoring in a VA primary care clinic.
Methods:
We conducted a randomized controlled trial of two approaches to engage patients in home blood pressure monitoring for hypertension care. One approach used a text-enabled cellular telephone (Pocket PC), and the second approach used conventional contact with clinic staff (phone, fax, or mail). Pocket PC data transmission used secure non-proprietary software. All participating patients were referred to the study by their primary care providers (PCP’s) because of inability to reach a blood pressure of 140/90 with standard care. All underwent standardized education on BP measurement and were then randomized into two groups. Both groups submitted home BP and pulse readings to a nurse care manager (NCM) by either the electronic tool (Pocket PC group) or conventional methods (standard care group). The NCM assessed the readings and carried out BP treatment plans ordered by each PCP. Patients were followed until the BP goal was reached or until six months following enrollment.
Results:
Eighty six patients followed by nine different PCP’s were enrolled, and all but six completed the study. Patients using the Pocket PC achieved greater reductions of both systolic BP (28 vs 24 points) and diastolic BP (17 vs 10 points, p < .02) than patients in the standard care group. While there were similar rates of achieving the BP goal (79% for Pocket PC vs 76% for standard care), there was a trend toward a shorter duration of time until reaching goal with the Pocket PC (93 vs 108 days).
Implications:
Patients using a Pocket PC for home monitoring achieved greater BP reduction and reached BP goals an average of two weeks sooner than patients using conventional methods to transmit BP readings to the clinic.
Impacts:
This approach used open source software and wireless technology that is now widely available. It is a promising approach suitable for dissemination and evaluation in diverse primary care settings.
