The physician at a distance: the use of videoconferencing in the treatment of patients with hypertension

Abstract

We evaluated the feasibility and quality of uncomplicated hypertension care based on telemedicine in a rural area of northern Sweden. The intervention subjects were 91 consecutive patients with primary hypertension. For comparison, 182 age- and sex-matched patients with hypertension were randomly selected from a similar health centre. The telemedicine equipment consisted of a video link between the physician and the patients, supported by a system for accessing medical data via the Internet. During a 21-month study period, telemedicine was used in 270 (91%) of the 297 consultations in the intervention group. All health personnel involved in the telemedicine treatment rated the method as feasible. Both systolic and diastolic blood pressure improved in the two groups during the study period. In the intervention group, a higher proportion had their blood pressure within treatment goals (systolic blood pressure <140 mmHg, diastolic blood pressure <90 mmHg) both at baseline and at follow-up than in the comparison group. An adjusted multivariate model (adjustment for sex, age, time between visits, change in number of drugs between first and last visit, blood pressure at first visit) showed that the intervention group had a higher probability (OR 2.7, 95% CI 1.4-5.2) of reaching the target blood pressure levels than the reference group. Treatment of hypertension by means of telemedicine was quite feasible and at least as effective as face-to-face consultations with a physician.

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“…As telemedicine offers a wide field of possible features, some of them could even spare time in everyday clinical routine. Nilsson et al [25] sent a nurse to patients who measured their blood pressure and, if necessary, contacted a doctor by video conference. Levy et al [26] asked patients to monitor their blood sugar levels themselves and send the data via text message to a nurse who reviewed them and, if necessary, adjusted the insulin dose.…”

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“…Another study by Bosworth et al examined the effectiveness of a decision support system and telephone education to patients to improve BP control [13]. One study by Nilsson et al evaluated the feasibility of telemedicine via videoconferencing with the nurses or physicians to manage hypertension [14]. A study by Svetkey et al tested an intervention to increase physician adherence to JNC-7 guidelines and patient adherence to the lifestyle recommendations of the JNC-7 guidelines for controlling BP [15].…”

“…Various methods of diagnosing hypertension for the eligible subjects were used in the studies such as diagnosis based on the Outpatient diagnostic codes [13,15], recently filled prescription for hypertension [5,13], self-reported by the subjects [6,9,10], diagnosed by a physician [5,6,9] and based on the BP value of patients [5,7,8,[10][11][12]14,16]. Some studies included more than one method of diagnosis of hypertension and some studies used different cut-off values for BP to diagnosed hypertension (Table 1).…”

“…The various age limits employed in the studies were > 18 years, 18 years, 25 years, > 50 years, > 55 years, 18-80 years, 35-65 years and 35-85 years. 5 studies also included other criteria for the target audience such as those with kidney disease [14,15], diabetes [14], cardiovascular diseases [11,15], other comorbidities [5], acute illnesses [16] and those who were pregnant [5,15] could not participate in the trial. One study specifically targeted those with stage 3 Chronic Kidney Disease [12].…”

“…The study settings included clinical [6,13,15,16], home-based [5,7,8,11,12,14], community-based [6,9] or work-place [10] (Table 2). …”