Cost-effectiveness of telehealth with remote patient monitoring for postpartum hypertension

Niu, Brenda; Mukhtarova, Narmin; Alagöz, Oğuzhan; Hoppe, Kara K.

doi:10.1080/14767058.2021.1956456

Cited by 32 publications

(24 citation statements)

References 14 publications

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“…Searches for the full review yielded 16,105 records, of which 380 were retrieved and screened in full text. Thirteen studies (in 18 articles [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] ) pertained to home BP monitoring: three RCTs, two nonrandomized comparative studies, and eight single-arm studies (see Fig. 1 for the literature flow diagram and Appendix 2, available online at http://links.lww.com/AOG/ D229, for design details).…”

Section: Resultsmentioning

confidence: 99%

“…The studies were published between 2017 and 2022 and included 3,867 participants. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Eleven studies were conducted in the United States, one was conducted in the United Kingdom, and one was conducted in India. The three RCTs had a total of 510 participants, the two nonrandomized comparative studies had 901 participants, and the eight single-arm studies had 2,456 participants.…”

Section: Resultsmentioning

confidence: 99%

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Postpartum Home Blood Pressure Monitoring

Steele,

Adam,

Saldanha

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP–monitoring regimens. DATA SOURCES: Search of Medline, Cochrane, EMBASE, CINAHL, and ClinicalTrials.gov from inception to December 1, 2022, searching for home BP monitoring in postpartum individuals. METHODS OF STUDY SELECTION: We included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, we extracted demographics and outcomes to SRDR+. TABULATION, INTEGRATION, AND RESULTS: Thirteen studies (three RCTs, two nonrandomized comparative studies, and eight single-arm studies) met eligibility criteria. All comparative studies enrolled participants with a diagnosis of hypertensive disorders of pregnancy. One RCT compared home BP monitoring with bidirectional text messaging with scheduled clinic-based BP visits, finding an increased likelihood that at least one BP measurement was ascertained during the first 10 days postpartum for participants in the home BP–monitoring arm (relative risk 2.11, 95% CI 1.68–2.65). One nonrandomized comparative study reported a similar effect (adjusted relative risk [aRR] 1.59, 95% CI 1.36–1.77). Home BP monitoring was not associated with the rate of BP treatment initiation (aRR 1.03, 95% CI 0.74–1.44) but was associated with reduced unplanned hypertension-related hospital admissions (aRR 0.12, 95% CI 0.01–0.96). Most patients (83.3–87.0%) were satisfied with management related to home BP monitoring. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. CONCLUSION: Home BP monitoring likely improves ascertainment of BP, which is necessary for early recognition of hypertension in postpartum individuals, and may compensate for racial disparities in office-based follow-up. There is insufficient evidence to conclude that home BP monitoring reduces severe maternal morbidity or mortality or reduces racial disparities in clinical outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022313075.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Postpartum Home Blood Pressure Monitoring

Steele,

Adam,

Saldanha

et al. 2023

Obstetrics &Amp; Gynecology

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“…Data from these pilot studies indicate remote BP monitoring is entirely feasible and acceptable to patients and providers. It results in higher quality-adjusted years, a signi cant reduction in postpartum readmissions, 3.7% (8/214) versus 0.5% (1/214) [45] . Moreover, the average cost of telehealth was reported to be $309 per patient, and was cost-effective to a cost of $420 per patient.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, telehealth could reduce health care costs in the US by approximately $31 million a year. [45] .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Poor Adherence to Blood Pressure Monitoring in Postpartum Discharged Patients with Hypertensive Disorders of Pregnancy

Zhou

Wang

et al. 2023

Preprint

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Background This study aims to investigate the risk factors for poor adherence to BP monitoring within 3 months after discharge from the hospital in postpartum discharged HDP patients. Likewise, females with hypertensive disorders of pregnancy (HDP) in China should have a blood pressure (BP) evaluation continuously for at least 42 days postpartum and have BP, urine routine, and lipid and glucose screening for 3 months postpartum. Methods This study is a prospective cohort study of postpartum discharged HDP patients. After telephone follow-up was conducted at 1 week, 6 weeks, and 12 weeks after discharge, the maternal demographic characteristics, labor and delivery details, laboratory test results of patients at admission, and adherence to BP monitoring after discharge were collected. While logistic regression analysis was used to analyze the factors related to poor adherence to BP monitoring, the receiver operating characteristic (ROC) curve was drawn to evaluate the model’s predictive value for the poor adherence to BP monitoring. Results In this study, 272 females met the inclusion criteria, and poor adherence to BP monitoring was presented in 182 patients (66.9%). A multivariate logistic regression analysis identified the education level of high school or below (OR 2.787, 95% CI 1.452–5.351), parity (OR 1.622, 95% CI 1.007–2.612), and delivery gestational age (OR 1.254, 95% CI 1.053–1.493) as independent risk factors in predicting a poor adherence to BP monitoring. The ROC curve analysis indicated that the continuous variable delivery gestational age had a significant predictive value for the poor adherence to BP monitoring, which resulted in a cutoff point of 33.4 weeks. Parity had a limited predictive value, with a cutoff point of 2. The established prediction regression model combined education level, parity and delivery gestational age had the maximal area under the curve (AUC, AUC = 0.746) and better sensitivity (66.5%) and specificity (71.1%). Conclusion Poor adherence to BP monitoring is a common state in postpartum HDP patients after discharge. Females with an education level of high school or below, a parity of two or more, and delivered at gestational age ≥ 33.4 weeks were unlikely to adhere to BP monitoring after discharge.

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“…23 There also are data to suggest that a virtual health care model with remote BP monitoring is cost effective. 24 We can take advantage of this momentum, and the framework already in place, to innovate and redesign care models for postpartum hypertension incorporating proven strategies that utilize virtual care. The first step is education and incorporation within a wide range of Ob-Gyn practices including Certified Nurse Midwifes, Ob-Gyn Specialists, and Maternal-Fetal Medicine providers.…”

Section: How Can Obstetricians and Primary Care Physicians Redesign P...mentioning

confidence: 99%

Redesigning Care for the Management of Postpartum Hypertension: How Can Ob–Gyns and Primary Care Physicians Partner in Caring for Patients after a Hypertensive Pregnancy?

et al. 2023

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The standard care model in the postpartum period is ripe for disruption and attention. Hypertensive disorders of pregnancy (HDPs) can continue to be a challenge for the postpartum person in the immediate postpartum period and is a harbinger of future health risks. The current care approach is inadequate to address the needs of these women. We propose a model for a multidisciplinary clinic and collaboration between internal medicine specialists and obstetric specialists to shepherd patients through this high-risk time and provide a bridge for lifelong care to mitigate the risks of a HDP. Key Points

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Cost-effectiveness of telehealth with remote patient monitoring for postpartum hypertension

Cited by 32 publications

References 14 publications

Postpartum Home Blood Pressure Monitoring

Postpartum Home Blood Pressure Monitoring

Risk Factors Associated with Poor Adherence to Blood Pressure Monitoring in Postpartum Discharged Patients with Hypertensive Disorders of Pregnancy

Redesigning Care for the Management of Postpartum Hypertension: How Can Ob–Gyns and Primary Care Physicians Partner in Caring for Patients after a Hypertensive Pregnancy?

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