Management of Cardiovascular Risk Factors Is Leaving the Office: Potential Impact of Telemedicine*

Abstract

J Clin Hypertens (Greenwich). 2011;13:791–794. ©2011 Wiley Periodicals, Inc. Effective control of hypertension and the other cardiovascular risk factors has been dependent on primary medical care as provided by family practitioners and internists. The progressive reduction in availability of primary care for adult populations in the United States threatens the likelihood of better control of the risk factors and potential loss of opportunity for prevention of cardiovascular disease. Recent progress has been made in the use of home blood pressure monitoring for improvement in classification of risk for hypertensive patients. Several studies establish the feasibility of home pressure monitoring combined with telemedicine for improving control of hypertension. Some studies have explored the role of self‐care for adjustment of medication, as well. The potential growth of this strategy for effective control of hypertension with reduced need for face‐to‐face encounter time in primary care is a promising solution to the reduction in primary care providers. Management of hyperlipidemia and diabetes by telemedicine is also being explored, particularly for rural areas, but may also be effective in urban settings. Development of technology for home monitoring together with electronic communication to providers and mechanisms for education, feedback, and warnings offers a promising solution to the possible crisis in prevention of cardiovascular disease due to the loss of traditional primary care.

Blood Pressure Control in a Hypertension Telemedicine Intervention: Does Distance to Primary Care Matter?

“…Although veterans with increased travel distances completed fewer primary care encounters, this was not associated with the telemedicine intervention even though many patients prefer the convenience of telemedicine encounters because of the ability of technology to overcome transportation barriers, travel time, and cost. 3,34 This finding may be related to travel pay incentives offered to veterans by the VHA to help overcome financial barriers to travel. Additionally, this practice may also incentivize face-to-face encounters rather than telemedicine encounters for some patients.…”

“…1 However, the primary care workforce is currently unable to meet the demand for clinic visits to manage patients with chronic diseases. 2,3 The demand for primary care is expected to increase further with expansion of healthcare availability under the 2010 Patient Protection and Affordable Care Act (PPACA). 4 Furthermore, our current healthcare system is designed to deliver services primarily through faceto-face encounters between a patient and healthcare provider.…”

“…This model, however, is likely unsustainable as the demand for healthcare services continues to grow. 3,5 Telemedicine is the use of telecommunication technologies and the exchange of electronic medical information between different sites to improve patients' health status. 6 Telemedicine can support the delivery of health services over geographic distances 7 and increase access to healthcare services for patients who live in rural areas.…”

The quality of cardiovascular disease prevention in rural primary care

“…Brief advice given by a general practitioner (GP) or general practice staff during routine consultations has been shown to improve the quality of CVD management and prevention, particularly in relation to smoking cessation . Therefore, systematic identification of risk factors and brief interventions in the form of lifestyle counselling can improve the quality of CVD management and prevention …”

Home Blood Pressure Monitoring

“…With the increasing need for primary care physicians, especially in the United States, telemedicine for hypertension may become a valuable alternative for management of hypertension. 4 An important issue for management of hypertension has been whether the relationship between the clinic pressures and out-of-clinic pressures provides useful information. When this comparison discloses that clinic pressure is significantly higher than out-of-office pressure, that is, a whitecoat effect, is the prognosis truly better?…”