Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

Patil, Sachin S.; Wareg, Nuha K.; Hodges, Kelvin L.; Smith, Jamie; Kaiser, Mark J.; Lefevre, Michael

doi:10.1370/afm.2491

Cited by 9 publications

(9 citation statements)

References 45 publications

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“…To account for expected variability of blood pressure readings across days and time of day, studies take different approaches including averaging multiple readings. [48][49][50] We took a conservative approach and calculated the average blood pressure in months 3 and 6 (including all measures during the respective month) and calculated the change from preenrollment measures from the EHR. Participants were included if they had at least one measure during the respective month.…”

Section: Pilot Phasementioning

confidence: 99%

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community

Kim,

McGrath,

Solorza

et al. 2023

Appl Clin Inform

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Background. Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the COVID-19 pandemic. Objectives. The objective of the ACTIVATE project was to co-design a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. Methods. ACTIVATE was a digital health intervention implemented in three phases—community codesign, feasibility assessment, and a pilot phase. Pre- and post-intervention outcomes included regularly-collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. Results. Participants were adult patients with uncontrolled diabetes and/or hypertension (n=50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a six-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (SD 2.81) at three months, and 4.19 (SD 2.69) at six months. The vast majority of patients achieved an A1c in the target range for control (7.0 %to 8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mmHG (SD 21.40) at three months and 13.55 (SD 23.31) at six months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). Conclusions. The ACTIVATE pilot demonstrated that a co-designed solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.

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Section: Pilot Phasementioning

confidence: 99%

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community

Kim,

McGrath,

Solorza

et al. 2023

Appl Clin Inform

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“…2 Yet only 24% to 54% of Americans with diagnosed hypertension have controlled BP. 3,4 Clinical uncertainty about how a single measured BP represents overall hypertension control contributes to high rates of uncontrolled hypertension, 5,6 and, in the case of a possible white coat effect, risk of causing hypotension. [7][8][9][10] This uncertainty leads to postponing medication intensification to gather more data, contributing to the phenomenon of clinical inertia.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Home BP data may help improve decisional certainty. 6 Evidence suggests that home BP predicts cardiovascular outcomes even after accounting for in-clinic BPs, prompting the US Preventive Services Task Force and professional societies to promote in their guidelines the inclusion of home data for hypertension diagnosis and management. 1,[14][15][16] Fifty-four percent of US adults with diagnosed hypertension report measuring their BP at home.…”

Section: Introductionmentioning

confidence: 99%

Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision Making in Primary Care

et al. 2022

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PURPOSE Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper. METHODSWe video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings. RESULTSHome BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing.CONCLUSIONS Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits.

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“…Clinical pharmacists, who assist patients in managing chronic conditions in primary care clinics [ 4 , 5 ], provide effective management of hypertension [ 6 , 7 ]. Another strategy for hypertension management is home blood pressure monitoring [ 8 - 12 ], although concerns about data quality and latency are widespread in instances where patients maintain paper-based logs for self-monitoring [ 13 - 15 ]. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology.…”

Section: Introductionmentioning

confidence: 99%

Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

Buis¹,

Roberson²,

Kadri³

et al. 2020

J Med Internet Res

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Background Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8059

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Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

Cited by 9 publications

References 45 publications

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community

Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision Making in Primary Care

Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

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