Background Hypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximize efficiency of care delivery and optimize control. Hypothesis We aimed to develop a remote, navigator‐led hypertension innovation program that would leverage algorithmic care pathways, home BP measurements and patient coaching to allow rapid and complete medication titration. Methods A multidisciplinary group of clinical experts from subspecialties and primary care collaborated to develop an evidence‐based clinical algorithm, designed to be automated and administered by non‐licensed patient navigators. In the development stage, a prospective pilot cohort of 130 patients was managed by nurse practitioners and pharmacists to ensure efficacy and safety. Patients with clinic BP ≥ 140/90 mm Hg were enrolled and given a Bluetooth‐enabled BP device. Home BPs were transmitted automatically into the electronic medical record. Medication titrations were performed by phone at biweekly intervals, based upon weekly average BP, until home BP was controlled at <135/85 mm Hg. Results Eighty‐one percent of all enrolled, and 91% of those patients who regularly measured home BP achieved goal, in an average of 7 weeks. Control was reached similarly across races, genders, and ages. Conclusions A home‐based BP control program run by non‐physicians can provide efficient, effective and rapid control, suggesting an innovative paradigm for hypertension management. This program is effective, sustainable, adaptable, and scalable to fit current and emerging national systems of healthcare.
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. Objectives To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. Methods In this single centre retrospective study, all ambulatory cardiovascular encounters occurring between March 16th - June 19th, 2020 were assessed. Baseline characteristics by visit type (in-person, TM-phone, TM-video) were compared using Chi-square and student t-tests, with statistical significance defined by p value < 0.05. Multivariate logistic regression was used to explore the predictors of TM versus in-person care. Results 8446 patients (86% Non-Hispanic White, 42% female, median age 66.8 +/- 15.2 years) completed an ambulatory cardiovascular visit during the study period. TM-phone (n = 4,981, 61.5%) was the primary mode of ambulatory care followed by TM-video (n = 2693, 33.2%). Non-Hispanic Black race (OR 0.56; 95% CI: 0.35 - 0.94, p-value=0.02), Hispanic ethnicity (OR 0.53; 95% CI: 0.29 - 0.98, p = 0.04), public insurance (Medicaid OR 0.50; 95% CI:0.32 – 0.79, p = 0.003, Medicare OR 0.65; 95% CI: 0.47– 0.89, p = 0.009), zip-code linked median household income (MHI) of <$75,000, age >85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM-video encounters and a higher likelihood of in-person care. Conclusions Significant disparities in TM-video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups.
Although 350,000 out-of-hospital cardiac arrest (OHCA) events 13 occur annually in the U.S. with rates of survival to hospital discharge 14 of <10%, 1,2 survival is even lower for residents in Black communi-15 ties. 3 A significant contributor to this disparity is lower rates of 16 bystander cardiopulmonary resuscitation (CPR) 4 due to lower CPR 17 training rates in non-White communities. 5 In response, many states 18 have enacted legislation to provide school-based CPR training to 19 promote universal CPR competence. However, the COVID-19 pan-20 demic has limited in-person education. We piloted a virtual CPR 21 training program for high school students of predominantly non-22 White race during the pandemic and examined whether this 23 approach could be effective in building knowledge and confidence 24 in delivering bystander CPR.
Introduction Known racial, ethnic, age, and socioeconomic disparities in video telemedicine engagement may widen existing health inequities. We assessed if telemedicine disparities were alleviated among patients of high video use providers at a large cardiovascular practice. Methods All telemedicine visits from March 16th-October 31st, 2020 and patient demographics were collected from an administrative database. Providers in the upper quintile of video use were classified as high-video-use providers. Descriptive statistics and a multivariable logistic model were calculated to determine the distribution and predictors of a patient ever having a video visit versus only phone visits. Results A total of 24,470 telemedicine visits were conducted among 18,950 patients by 169 providers. Video visits accounted for 48% of visits (52% phone). Among telemedicine visits conducted by high-video-use providers (n = 33), ever video patients were younger (P<.001) and included 78% of Black patients versus 86% of White patients (P<.001), 74% of Hispanic patients versus 86% of non-Hispanic patients (P<.001), and 79% of public insurance patients versus 91% of private insurance patients (P<.001). High-video-use provider patients had 9.4 (95% confidence interval, 8.4-10.4) times the odds of having video visit compared to low-video-use provider patients. Discussion These results suggest that provider-focused solutions alone, including promoting provider adoption of video visits, may not adequately reduce disparities in telemedicine engagement. Even in the presence of successful clinical infrastructure for telemedicine, individuals of Black race, Hispanic ethnicity, older age, and with public insurance continue to have decreased engagement. To achieve equity in telemedicine, patient-focused design is needed.
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