Effects of technology-enabled blood pressure monitoring in primary care: A quasi-experimental trial

Abstract

Introduction Technology to enhance hypertension management is increasingly used in primary care; however, it has not been evaluated in an Asian primary care setting. We aimed to understand the clinical impact and cost-effectiveness of a technology-enabled home blood pressure monitor when deployed in primary care, and patients’ perspectives about the technology. Methods A quasi-experimental cohort study was conducted in a polyclinic in Singapore. In total, 120 patients with hypertension were assigned to the telemonitoring intervention group. Patients received a home blood pressure device connected to the clinical care team's dashboard through a mobile gateway. Tele-consultations and nurse-led tele-support were carried out using established clinical protocols. In total, 120 patients assigned to the control group continued to receive usual care in the polyclinic. Clinical outcomes, cost-effectiveness, and patient satisfaction were measured 6 months after recruitment. Results In total, 217 patients completed 6 months of follow-up. Telemonitoring intervention patients had significantly increased odds of having controlled blood pressure by a factor of 2.69 ( p = 0.01), with the greatest improvement in those whose blood pressure was uncontrolled at baseline ( p < 0.05). The incremental cost-effectiveness ratios for all patients was S$23,935.14/quality-adjusted life year (<1 gross domestic product per capita), which was very cost-effective based on World Health Organization cost-effectiveness thresholds. There was greater satisfaction in telemonitoring intervention group relating to the convenience of recording and sharing blood pressure measurements with the health care team, consultation advice received, understanding by the health care team of their condition, and were more motivated to monitor their blood pressure. Discussion Telemonitoring with tele-consultation improved blood pressure control and was more cost-effective than usual care. Patients receiving telemonitoring intervention were also more motivated and satisfied with their care.

Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension

“…6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30][31] An incremental analysis of costs and outcomes was conducted in 15 studies (94%). 6,[13][14][15]20,21,[23][24][25][26][27][28][29][30][31] A sensitivity analysis was conducted in 15 studies (94%). 6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30] The majority of the studies provided a comprehensive assessment of the costeffectiveness of the intervention over the control.…”

“…6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30] All of the studies adequately described the study setting and discussed the issue of generalizing the results to a different setting with similar characteristics. 6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30][31]…”

“…The definition of usual care had minor differences but was generally considered as patients monitored per usual clinical care from their clinician without self-BP monitoring. 31 All articles included an intervention in which patients self-measured their BP at home using an electronic device and transferred their BP results to clinicians at a different location (ie, HBPM). HBPM was classified into 3 categories 37 : HBPM alone, HBPM with additional support (eg, basic website, online patient portals, or telephone consultations with clinicians or nurses 17 ), and HBPM within team-based care (TBC), which involved more labor-intensive efforts, often combined with other behavioral interventions, such as pharmacist care [17][18][19] or nurse behavioral interventions.…”

“…Among the 16 studies, 7 utilized CEA, 6,14,16,20,21,25,29 6 used CUA, 13,23,[26][27][28]30 and 3 utilized both CUA and CEA. 15,24,31 A societal perspective was only reported in 2 studies, 16,31 and the rest were conducted using a health care system perspective. 6,[13][14][15]20,21,[23][24][25][26][27][28][29][30] The types of costs reported in each article were different, with 3 studies reporting direct medical costs only, 14,28,31 1 reporting only program costs, 20 and 12 reporting both 6,13,15,16,21,[23][24][25][26][27]29,30 (Table 2).…”

“…Of the 16 identified studies, 9 reported that an at-home BP monitoring intervention (HBPM or ABPM) had an ICER within the WTP thresholds, indicating the intervention as cost-effective compared with clinical UC. 13,15,23,24,[26][27][28]30,31 Of the remaining 7, all were studies with time periods ranging from 6 to 24 months. 6,14,16,20,21,25,29 Of the 12 identified studies that compared the cost-effectiveness of HBPM vs UC, 5 (42%) reported the intervention as being cost-effective.…”