Study Finds Blood Pressure Telemonitoring Feasible for Most Veterans
The potential for technological advances to improve health care for the elderly outside the clinic setting may be limited by the extent to which patients are able to successfully incorporate them into their daily lives. This article reports on the first six months of the Hypertension Intervention Nurse Telemedicine Study - an 18-month randomized clinical intervention to improve blood pressure (BP) control. Findings reported here focus on the feasibility of using home BP telemonitoring devices to manage BP among Veterans. Of the 588 Veterans participating, 147 received usual care and 441 received one of three interventions: 1) nurse-administered tailored behavioral intervention; 2) nurse-administered medication management according to a hypertension decision support system, and 3) combination of the first two interventions. The interventions were triggered based on home BP values transmitted by participating Veterans, who were VA outpatients between 5/06 and 11/07, via telemonitoring devices over standard telephone lines to a secure server. Technical alerts were generated if patients did not transmit their BP readings according to the protocol.
Findings show that 75% of Veterans using the BP intervention were able to set up the telemonitoring devices and adhere to the study protocol. During the first six months of this study, 693 technical alerts were generated by 267 Veterans: 61% of the alerts were attributed to patient non-adherence, and 5% were attributed to a lack of patient knowledge (e.g., difficulty setting up the equipment, putting on the BP cuff). Veterans who generated more than two technical alerts were younger (60.5 years of age vs. 64.5 years), less likely to be Caucasian (36% vs. 53%), and less likely to be retired (38% vs. 54%) than those who triggered two or fewer alerts. The authors suggest that despite the possibilities of improving health care using home BP telemonitoring equipment, there are groups who may require more support using this technology.
McCant F, McKoy G, Grubber J, Olsen M, Oddone E, Powers B, and Bosworth H. Is telemedicine a panacea for chronic care? Feasibility of blood pressure telemonitoring in patients with poor blood pressure control. Journal of Telemedicine and Telecare September 2009;15(6): 281-85.
This study was funded by HSR&D. Dr. Bosworth was supported by a VA Research Career Scientist Award. All authors are part of HSR&D's Center for Health Services Research in Primary Care in Durham, NC.