Effects of Nurse-Managed Telemonitoring on Blood Pressure at 12-Month Follow-Up Among Urban African Americans

Artinian, Nancy T.; Flack, John M.; Nordstrom, Cheryl K.; Hockman, Elaine M.; Washington, Olivia G. M.; Jen, K.‐L. Catherine; Fathy, Maryam

doi:10.1097/01.nnr.0000289501.45284.6e

Cited by 98 publications

(111 citation statements)

References 8 publications

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“…We found, as have others, that better hypertension control can be achieved when self-measurement of BP is part of a plan that increases patient engagement in making management decisions. Previous studies achieved good results by directly linking home BP monitoring with some form of regular professional supervision, such as telecounseling 8 or implementing action plans established by a pharmacist, 9 nurse, [10][11][12] or family physician. 7,13 These interventions required a health professional to examine all of the transmitted readings for trends and extreme values and to contact patients with a management plan.…”

Section: Discussionmentioning

confidence: 99%

“…9,13 However, several telemonitoring studies, including our own, have shown that better outcomes can be achieved without a change in the number or types of antihypertensive medications prescribed or in the proportion of subjects whose treatment was adjusted during the study. 8,10,17 In one study this improvement was related to better adherence to antihypertensive medications. 17 Another study showed a decrease in BP in the home monitoring service group irrespective of whether there was a medication change.…”

Section: Discussionmentioning

confidence: 99%

“…6 In the telemonitoring studies, however, a physician or member of the healthcare team reviewed the transmitted data and contacted the patients to adjust antihypertensive treatment. [7][8][9][10][11][12][13] Thus, it is unclear whether the better outcome was related to the use of a telemonitoring system or the increased involvement of healthcare providers in the treatment process.…”

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confidence: 99%

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Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

et al. 2012

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Abstract-Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients.In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (nϭ55) or control (nϭ55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1Ϯ15.6 mmHg (SD; PϽ0.0001), and the mean between-group difference was 7.1Ϯ2.3 mmHg (SE; PϽ0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of Ͻ130/80 mmHg compared with 31% of control subjects (PϽ0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1Ϯ3.76; exit, 5.2Ϯ4.30; Pϭ0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. 3 Such results spurred development of chronic care models that engage patients in their own care. 4 Home BP monitoring promotes self-care, improves BP control, and is endorsed by several prominent organizations as an adjunct to hypertension treatment. 5 A recent meta-analysis suggested that adding telemonitoring to self-measurement of BP is even more effective in reducing BP. 6 In the telemonitoring studies, however, a physician or member of the healthcare team reviewed the transmitted data and contacted the patients to adjust antihypertensive treatment.7-13 Thus, it is unclear whether the better outcome was related to the use of a telemonitoring system or the increased involvement of healthcare providers in the treatment process.Previously we reported the development of a home BP telemonitoring system that provided self-care messages on the smartphone of patients immediately after each reading. A.G.L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. None of the other authors has real or perceived conflicts of interest related to the study.This trial has been registered at www.clinicaltrials.gov (identifier NCT00717665 eliminate the need for a health provider to re...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

et al. 2012

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“…Five articles 27,29,30,37,38 reported combinations of SMBP, behavioral counseling, or telemedicine interventions for hypertensive patients. Telemonitoring interventions included use of SMBP and telephone counseling, 37 SMBP plus weight and exercise self-monitoring, 30 SMBP in combination with telecounseling that targeted blood pressure [BP] goals, 27 use of medication protocol adjustments that targeted BP goals and BP transmitted from SMBP by participants, 38 and SMBP plus tailored lifestyle modification (eg, DASH [Dietary Approaches to Hypertension] diet, medication use).…”

Section: Barnason Et Al Tpe Interventions For Self-managementmentioning

confidence: 99%

“…Telemonitoring interventions included use of SMBP and telephone counseling, 37 SMBP plus weight and exercise self-monitoring, 30 SMBP in combination with telecounseling that targeted blood pressure [BP] goals, 27 use of medication protocol adjustments that targeted BP goals and BP transmitted from SMBP by participants, 38 and SMBP plus tailored lifestyle modification (eg, DASH [Dietary Approaches to Hypertension] diet, medication use). 29 Behavioral interventions reported in 6 articles 28,34,36,[39][40][41] did not include the use of SMBP.…”

Section: Barnason Et Al Tpe Interventions For Self-managementmentioning

confidence: 99%

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

Barnason¹,

White‐Williams²,

Rossi³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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A lthough the overall rate of death associated with cardiovascular disease (CVD) continues to decline in the United States, [1][2][3] CVD is a leading cause of mortality and disability. The burden of CVD remains high, underscoring the need to improve long-term management of CVD as a chronic illness. Effective implementation of current treatment guidelines for primary and secondary prevention of CVD relies heavily on patient knowledge and engagement in carrying out the plan of care. Healthcare reforms have increasingly shifted the responsibility for self-management to patients and families as hospital stays and ambulatory visits have become shorter and less frequent.Background-The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. Methods and Results-An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches. Conclusions-This synthesis of evidence expands the base of knowledge related to the development of patient selfmanagement skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients. (Circ Cardiovasc Qual Outcomes. 2017;10:e000025.

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The Potency of Team-Based Care Interventions for Hypertension

Carter

Rogers²,

Daly³

et al. 2009

Arch Intern Med

303

252

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Background One strategy that has had the greatest effect on improving blood pressure (BP) includes team-based care. The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists. Methods A Medline search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by two reviewers who independently abstracted data and classified the different intervention components. Results Thirty-seven papers met the inclusion criteria. Education on BP medications was significantly associated with improved BP (−8.75/−3.60 mm Hg). Other strategies that had large effect sizes on SBP included: pharmacist made treatment recommendation (−9.30 mm Hg), nurse did the intervention (−4.80 mm Hg), and a treatment algorithm was used (−4.00 mm Hg). The odds ratio (OR) and 95% confidence interval (CI) for controlled BP were: nurses OR=1.69 (CI = 1.48, 1.93), pharmacists within primary care clinics OR=2.17 (CI = 1.75, 2.68) and community pharmacists OR=2.89 (CI = 1.83, 4.55), Mean reductions in SBP were: nursing studies = 5.84 ± 8.05 mm Hg, pharmacists in clinics = 7.76 ± 7.81 mm Hg and community pharmacists = 9.31 ± 5.00 mm Hg but there was no significant differences between the nursing and pharmacy studies (p≥0.19). Conclusion Team-based care was associated with improved BP control and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in the health-care organizational structure to include important components of team-based care.

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Effects of Nurse-Managed Telemonitoring on Blood Pressure at 12-Month Follow-Up Among Urban African Americans

Abstract: : Telemonitoring of BP resulted in clinically and statistically significant reductions in systolic BP over a 12-month period; if maintained over a longer period of time, the reductions could improve care and outcomes significantly for African Americans with hypertension.

Cited by 98 publications

References 8 publications

Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

The Potency of Team-Based Care Interventions for Hypertension

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