Changes in blood pressure among patients in the Ontario Telehomecare programme: An observational longitudinal cohort study

Abstract

Background The objective of this study was to investigate the changes in blood pressure among patients enrolled in the Telehomecare programme in Ontario, Canada. Methods This observational study utilised a prospective longitudinal cohort design, including patients with heart failure and chronic obstructive pulmonary disease enrolled in the Ontario Telehomecare programme from July 2012 to July 2015. The outcome of interest was change in mean (biweekly) systolic and diastolic blood pressure levels over a six-month period. Patient data were extracted from the Ontario Telemedicine Network database, and analysed using generalised linear mixed model procedures. Results Overall, we analysed data for 3513 patients. Patients were on average 74.1 ± 11.4 years of age; almost half were men, 62% had heart failure, 55% chronic obstructive pulmonary disease and 29% diabetes. At baseline, the mean systolic and diastolic blood pressure levels were 130.4 ± 19.1 mmHg and 72.2 ± 12.5 mmHg for the total sample. At six months, the adjusted reduction in systolic and diastolic blood pressure values were 4.0 mmHg (95% confidence interval: -4.5 to -3.5) and 2.7 mmHg (95% confidence interval: -3.1 to -2.4), respectively. In a subgroup of 1220 patients with uncontrolled blood pressure at baseline (systolic/diastolic blood pressure of 150.7 ± 10.2 mmHg/80.2 ± 13.5 mmHg) the adjusted reduction in systolic blood pressure was 12.5 mmHg (95% confidence interval: -13.4 to -11.6) and in diastolic blood pressure was 7.1 mmHg (95% confidence interval: -7.8 to -6.5) over the six-month period. Conclusions Blood pressure levels were significantly reduced in patients enrolled in the Telehomecare programme, with changes being more pronounced in patients with uncontrolled blood pressure. The sustainability of decreased blood pressure on other clinical outcomes needs further evaluation.

Virtual health care for adult patients with intellectual and developmental disabilities: A scoping review

“…Daily self-measurements were monitored remotely by nurses with regular follow up by phone. 70 Another recent study described an approach spine surgeons can use to conduct remote ‘physical’ spine assessments by observing a range of prescribed movement patterns over video. 71 These projects suggest that it is possible to deliver a wide range of services virtually, but unfortunately patients with IDD are not typically included in these studies and it is unknown whether these programs would be successful for this population.…”

Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

“…Indeed, some of these challenges have already been reported in other studies. [1,19] The random coe cients model analysis had the advantage of using all the data, and of the four methods was thought to have controlled best for the 'white coat effect'. The other methods relied on assumptions about the degree of 'white coat effect' that may not have been true.…”

Examining the Effectiveness of Telemonitoring with Routinely Acquired Blood Pressure Data in Primary Care: Challenges in the Statistical Analysis

“…Indeed, some of these challenges have already been reported in other studies. [1,17] The random coe cients model analysis had the advantage of using all the data, and of the three methods was thought to have controlled best for the 'white coat effect'. The other methods relied on assumptions about the degree of 'white coat effect' that may not have been true.…”