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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3062 — Is Telemonitoring a Panacea for Chronic Care: Feasibility of Blood Pressure Telemonitoring in Patients with Poor Blood Pressure Control

McCant FA (Center of Excellence - Durham NC), McKoy GL (Center of Excellence - Durham NC), Grubber JM (Center of Excellence - Durham NC), Olsen KK (Center of Excellence - Durham NC), Powers BJ (Center of Excellence - Durham NC), Oddone EZ (Center of Excellence - Durham NC), Bosworth HB (Center of Excellence - Durham NC)

Objectives:
The Hypertension Intervention Nurse Telemedicine (HINTS) study is a randomized controlled trial focused on assisting veteran participants in lowering their blood pressure (BP) using a nurse interventionist and home BP telemonitoring devices. This paper seeks to evaluate the feasibility of using home BP telemonitoring devices for managing blood pressure among primary care patients.

Methods:
Each participant randomized to the intervention was trained and issued a home BP telemonitoring device. As participants measured their blood pressure, readings were transmitted through a standard telephone line to the study team. Based on the transmitted readings, patients could activate the intervention or safety alerts. Technical alerts were generated if patients did not transmit their BP readings according to the study protocol. All alerts were resolved by communication with the patient either via the nurse interventionist, if a safety or intervention alert was activated, or by research assistants if a technical alert was activated. The frequency and cause for technical alerts are described, as well as the patient characteristics that are associated with challenges using the home-telemonitoring equipment.

Results:
Five hundred and eighty-eight were enrolled and 441 were randomized to the intervention. During the first six months, 693 technical alerts were generated by 267 participants; 112 participants generated greater than two technical alerts. A majority of the alerts (n=421, 60.8%) were attributed to patient non-adherence (i.e., measuring their BP < 3 times over two weeks). Patients who generated > 2 technical alerts were younger (60.5 + 10.7 (SD) than those with 0-2 alerts (64.4 + 10.3 (SD) (p = 0.0006), and were more likely to be non-white (p = 0.002), and not retired (p = 0.003).

Implications:
Despite the possibilities of improving health care using home BP telemonitoring equipment, there is a group of patients who require more support using the technology.

Impacts:
If home-telemonitoring is to play a role in hypertension management, it is important that the VA develop better strategies to identify those most likely to benefit and develop ways to better support those who struggle using this equipment.


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