Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control

Ralston, James D.; Cook, Andrea J.; Anderson, Melissa L.; Catz, Sheryl L.; Fishman, Paul; Carlson, James A.; Johnson, Ron Kim; Green, B. B.

doi:10.4338/aci-2013-10-ra-0079

Cited by 51 publications

(19 citation statements)

References 31 publications

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“…18,25 That study likewise found that increased frequency of home BP monitoring, interactions with pharmacists, and medication intensification were mediators of the improved blood pressure control observed in the intervention group, while adherence and lifestyle changes were not. It is not surprising that both studies found that increased selfmonitoring and medication intensification were the major mediators of the intervention effect, since these were key components of the intervention.…”

Section: Discussionmentioning

confidence: 83%

“…6,10,13,18 Use of a home BP monitor was coded as follows: 0 = Bnone,^1 = "less than once per er month,^2 = Ba few times per month,^and 3 = Bonce a week or more.^BP medication class counts were gathered using medication inventories at baseline and follow-up, and ranged from 0 to 6. Self-reported adherence to BP medications was calculated as the sum of four items indicating non-adherence, and could range from 0 (good adherence) to 4 (poor adherence).…”

Section: Methodsmentioning

confidence: 99%

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A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

et al. 2015

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BACKGROUND: It is important to understand which components of successful multifaceted interventions are responsible for study outcomes, since some components may be more important contributors to the intervention effect than others. OBJECTIVE: We conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure (BP) after 6 months in a trial to improve hypertension control. DESIGN: The study was a preplanned secondary analysis of a cluster-randomized clinical trial. Eight clinics in an integrated health system were randomized to provide usual care to their patients (n=222), and eight were randomized to provide a telemonitoring intervention (n=228). PARTICIPANTS: Four hundred three of 450 trial participants completing the 6-month follow-up visit were included. INTERVENTIONS: Intervention group participants received home BP telemonitors and transmitted measurements to pharmacists, who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits. MAIN MEASURES: Path analytic models estimated indirect effects of the seven potential mediators of intervention effect (defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months). The potential mediators were change in home BP monitor use, number of BP medication classes, adherence to BP medications, physical activity, salt intake, alcohol use, and weight. KEY RESULTS: The difference in change in systolic BP was 11.3 mmHg. The multivariable mediation model explained 47 % (5.3 mmHg) of the intervention effect. Nearly all of this was mediated by two factors: an increase in medication treatment intensity (24 %) and increased home BP monitor use (19 %). The other five factors were not significant mediators, although medication adherence and salt intake improved more in the intervention group than in the usual care group. CONCLUSIONS: Most of the explained intervention effect was attributable to the combination of self-monitoring and medication intensification. High adherence at baseline and the relatively low intensity of resources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP.

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Section: Discussionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

et al. 2015

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“…A study evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension. 31 Study arms analysed were usual care with a home blood pressure monitor and pharmacist-assisted care with a home blood pressure monitor delivered via a patient website. At 12 months follow-up, patients in the web-based pharmacist care group were more likely to have a blood pressure below 140/90 mm Hg compared with patients in the group with home blood pressure monitors only (55% vs 37%; p=0.001).…”

Section: Discussion-literature Search Findingsmentioning

confidence: 99%

“…The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring, secure messaging and antihypertensive medication intensification. 31 …”

Section: Discussion-literature Search Findingsmentioning

confidence: 99%

Improving inflammatory arthritis management through tighter monitoring of patients and the use of innovative electronic tools

et al. 2016

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Treating to target by monitoring disease activity and adjusting therapy to attain remission or low disease activity has been shown to lead to improved outcomes in chronic rheumatic diseases such as rheumatoid arthritis and spondyloarthritis. Patient-reported outcomes, used in conjunction with clinical measures, add an important perspective of disease activity as perceived by the patient. Several validated PROs are available for inflammatory arthritis, and advances in electronic patient monitoring tools are helping patients with chronic diseases to self-monitor and assess their symptoms and health. Frequent patient monitoring could potentially lead to the early identification of disease flares or adverse events, early intervention for patients who may require treatment adaptation, and possibly reduced appointment frequency for those with stable disease. A literature search was conducted to evaluate the potential role of patient self-monitoring and innovative monitoring of tools in optimising disease control in inflammatory arthritis. Experience from the treatment of congestive heart failure, diabetes and hypertension shows improved outcomes with remote electronic self-monitoring by patients. In inflammatory arthritis, electronic self-monitoring has been shown to be feasible in patients despite manual disability and to be acceptable to older patients. Patients' self-assessment of disease activity using such methods correlates well with disease activity assessed by rheumatologists. This review also describes several remote monitoring tools that are being developed and used in inflammatory arthritis, offering the potential to improve disease management and reduce pressure on specialists.

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“…Papers discussed novel portal content like problem lists and its effect on user satisfaction [73] and its use in screening for substance abuse [74]. The use of portals in managing hypertension was also discussed [75].…”

Section: Health Information Exchange (Hie)mentioning

confidence: 99%

Improving Bridging from Informatics Practice to Theory

Lehmann

Gundlapalli

2015

Methods Inf Med

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SummaryBackground: In 1962, Methods of Information in Medicine ( MIM ) began to publish papers on the methodology and scientific fundamentals of organizing, representing, and analyzing data, information, and knowledge in biomedicine and health care. Considered a companion journal, Applied Clinical Informatics ( ACI ) was launched in 2009 with a mission to establish a platform that allows sharing of knowledge between clinical medicine and health IT specialists as well as to bridge gaps between visionary design and successful and pragmatic deployment of clinical information systems. Both journals are official journals of the International Medical Informatics Association. Objectives: As a follow-up to prior work, we set out to explore congruencies and interdependencies in publications of ACI and MIM. The objectives were to describe the major topics discussed in articles published in ACI in 2014 and to determine if there was evidence that theory in 2014 MIM publications was informed by practice described in ACI publications in any year. We also set out to describe lessons learned in the context of bridging informatics practice and theory and offer opinions on how ACI editorial policies could evolve to foster and improve such bridging. Methods:We conducted a retrospective observational study and reviewed all articles published in ACI during the calendar year 2014 (Volume 5) for their main theme, conclusions, and key words. We then reviewed the citations of all MIM papers from 2014 to determine if there were references to ACI articles from any year. Lessons learned in the context of bridging informatics practice and theory and opinions on ACI editorial policies were developed by consensus among the two authors. Results: A total of 70 articles were published in ACI in 2014. Clinical decision support, clinical documentation, usability, Meaningful Use, health information exchange, patient portals, and clinical research informatics emerged as major themes. Only one MIM article from 2014 cited an ACI article. There are several lessons learned including the possibility that there may not be direct links between MIM theory and ACI practice articles. ACI editorial policies will continue to evolve to reflect the breadth and depth of the practice of clinical informatics and articles received for publication. Efforts to encourage bridging of informatics practice and theory may be considered by the ACI editors. Conclusions: The lack of direct links from informatics theory-based papers published in MIM in 2014 to papers published in ACI continues as was described for papers published during 2012 to 2013 in the two companion journals. Thus, there is little evidence that theory in MIM has been informed by practice in ACI.

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Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control

Cited by 51 publications

References 31 publications

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

Improving inflammatory arthritis management through tighter monitoring of patients and the use of innovative electronic tools

Improving Bridging from Informatics Practice to Theory

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