Linking clinic and home

Abstract

Objective Older adults with chronic kidney disease have a high rate of uncontrolled hypertension. Home monitoring of blood pressure (BP) is an integral part of management, but requires that patients bring records to clinic visits. Telemonitoring interventions, however, have not targeted older, less technologically-skilled populations. Methods Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were randomized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub, which wirelessly transmitted readings (n= 28), or usual care (n= 15). Home recordings were reviewed weekly and telemonitoring participants were contacted if BP was above goal. The prespecified primary endpoints were improved data exchange and device acceptability. Secondary endpoint was BP change. Results Forty-three participants (average age 68 years, 75% white) completed the 6-month study. Average start-of-study BP was 147/78mmHg. Those in the intervention arm had a median of 29 (IQR 22, 53) transmitted BP readings per month, with 78% continuing to use the device regularly, whereas only 20% of those in the usual care group brought readings to in-person visits. The median number of telephone contacts triggered by the wireless monitoring was 2 (IQR 1, 4) per patient. Both groups had a significant improvement in systolic BP (P< 0.05, for both changes); systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5mmHg in usual care participants (P for comparison 0.31). Conclusion This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months.

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

“…The authors found improvement in BP in both groups with no statistically differences. 25 Participants using the home-based tele-monitoring device transmitted significantly more readings to their providers than the usual care participants reported at clinic. The intervention was well received by both participants and clinicians, and was determined to be cost-effective.…”

Current issues in the management and monitoring of hypertension in chronic kidney disease

“…Although there is no reason this should not be the case in patients with hypertension and CKD, the data in this population are still limited. A small RCT of home BP telemonitoring in older patients with CKD and uncontrolled hypertension showed that this was feasible in this population [18]. A larger study showing effectiveness for BP control from telemonitoring and pharmacist BP management included almost a fifth of individuals with CKD [19].…”

A mHealth-based care model for improving hypertension control in stroke survivors: Pilot RCT

“…We compared our use of technology including self-monitoring, automated transmission without need for patient BP data upload, and responsive provider driven medication management with the 13 RCT listed in the AHA statement. We found that 10/13 had some element of SMBP with home BP monitors, 18–27 only 4/13 had automated BP transmission. Of these, two were using modem based upload 25,27 and two had Bluetooth technology.…”

“…Of these, two were using modem based upload 25,27 and two had Bluetooth technology. 18,23 Furthermore, 6/13 had responsive provider driven anti-hypertensive medication management 18–21,26,27 and an additional 2/13 had medication management in office visits where SMBP data was used 22,23 . The low numbers of trials with automated transmission reflects the earlier time frame of these studies with many of them reported between 2008 and 2013.…”