A Telecommunications System for Monitoring and Counseling Patients With Hypertension Impact on Medication Adherence and Blood Pressure Control

Abstract

This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control. A randomized controlled trial was conducted in 29 greater Boston communities. The study subjects were 267 patients recruited from community sites who were >or= 60 years of age, on antihypertensive medication, with a systolic blood pressure (SBP) of >or= 160 mm Hg and/or a diastolic blood pressure (DBP) of >or= 90 mm Hg. The study compared subjects who received usual medical care with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months. Weekly, subjects in the telephone group reported self-measured blood pressures, knowledge and adherence to antihypertensive medication regimens, and medication side-effects. This information was sent to their physicians regularly. The main study outcome measures were change in antihypertensive medication adherence, SBP and DBP during 6 months, satisfaction of patient users, perceived utility for physicians, and cost-effectiveness. The mean age of the study population was 76.0 years; 77% were women; 11% were black. Mean antihypertensive medication adherence improved 17.7% for telephone system users and 11.7% for controls (P = .03). Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls (P = .02). Among nonadherent subjects, mean DBP decreased 6.0 mm Hg for telephone users, but increased 2.8 mm Hg for controls (P = .01). For telephone system users, mean DBP decreased more if their medication adherence improved (P = .03). The majority of telephone system users were satisfied with the system. Most physicians integrated it into their practices. The system was cost-effective, especially for nonadherent patient users. Therefore, weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertension patients. This system can be used to monitor patients with hypertension or with other chronic diseases, and is likely to improve health outcomes and reduce health services utilization and costs.

Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension

“…A direct positive effect of TBPM on BP control has been previously reported, 27 probably due to an optimized compliance. 28,29 The greater number of measurements during dosage titration gives the physician a higher certainty to act on. This was confirmed by the change of dosages after the 2nd ABPM.…”

Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension

“…Albeit limited in number, previous randomized controlled studies 8,16,17 have shown a beneficial effect of telemedical monitoring on blood pressure control. In 1996, Friedman et al 8 found that when hypertensive patients used a telephone-linked computer system to report their HBP, diastolic blood pressure decreased significantly.…”

“…Previous studies 8,16,17 have suggested a beneficial effect of telemedical monitoring on blood pressure control. However, to our knowledge, no study in a typical primary care setting has compared the accuracy of the conventional CBP with that of HBP, using a memory-equipped device with telemedical transmission capabilities.…”

“…Furthermore, it is generally associated with a better compliance to treatment and, in some studies, with a better blood pressure control. [6][7][8] Several medical organizations have encouraged the use of HBP, [9][10][11][12] but none of these reports gave clear guidelines concerning exactly how it should be used in practice. However, for clinical purposes, two measurements in the morning and in the evening for at least 3 days have been advised, 12,13 but important aspects still remain to be clarified.…”

Web-based telemedicine systems for home-care: technical issues and experiences

“…When coupled with dedicated solutions for instrument data transmission, CTI can also provide patients with feedback on their care. Several successful CTI applications have been tested in different medical problems, with particular reference to chronic patient's care [36]. Clearly, CTI alone may limit the applicability of the system, and should be always associated with Web based solutions for data access by the health care providers and patients themselves.…”