The use of at-home blood pressure monitors and web-based reporting tools that connect clinicians and patients via the Internet appears to significantly improve patients' ability to manage their high blood pressure to healthy levels, according to research from Kaiser Permanente.
The study, led by Kaiser Permanente Colorado in collaboration with the American Heart Association and Microsoft Corp., involved 348 patients with uncontrolled hypertension, ages 18-85 years. The initial study data was presented today by Kaiser Permanente Colorado researchers at the American Heart Association's 11th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.
"Kaiser Permanente Colorado's Institute for Health Research is committed to studying innovative ways to make care more patient-centered in order to improve quality," said lead author David Magid, MD, Kaiser Permanente senior scientist. "While more research is necessary, our study suggests that using technology to engage individuals in their care at home may be a better way to help patients achieve a healthy blood pressure."
As many as 73 million Americans have high blood pressure (hypertension), a leading predictor of heart disease. According to the American Heart Association, approximately 69 percent of people who have a first attack and 77 percent who have a first stroke suffer from elevated blood pressure levels. The participants were randomized to a usual care group or a home monitoring group. All patients had their blood pressure measured in the medical office at the start of the six-month study. The usual care group was managed in a typical model that involved checking blood pressure during office visits.
The home monitoring group used an at-home blood pressure device that uploaded data to the patient's account in Microsoft HealthVault, a security enhanced, Web-based data storage platform. At the time of entering the study, the participants opted into a Kaiser Permanente application that automatically transferred the home blood pressure readings to Kaiser Permanente's electronic disease registry. Kaiser Permanente's clinical pharmacists used the computerized registry to monitor readings and consulted with patients to adjust their antihypertensive medications based on proven protocols. Connected to HealthVault, patients were able to manage their data using Heart360, a free online tool provided by the American Heart Association.
At the start of the study, the average systolic blood pressure was 149 mm Hg in the home monitoring group and 145 mm Hg in the usual care group. At six months, patients in the home monitoring group were 50 percent more likely to have their blood pressure controlled to healthy levels compared to the usual care group. Similarly, a significantly greater decrease in systolic blood pressure at six months occurred in the home monitoring group (-21 mm Hg) versus the usual care group (-9 mm Hg).
Health experts have long known that the current approach to managing hypertension has its shortcomings. Patients often don't comply with in-person visits and when they do, the measurements can be inconsistent or inaccurate. In light of these shortcomings, the American Heart Association recently began recommending home monitoring. However, prior research conducted by Dr. Magid found that when patients used home monitoring, but were required to write down and call-in results, blood pressure goals only slightly improved. This latest study provides an additional layer of automation and convenience by directly feeding the readings from the home blood pressure cuff to the patient's care team via sophisticated health-IT tools.
"While the in-person doctor-patient relationship will always be a cornerstone of care, one day the use of coordinated, secure health information technologies based at home or work could complement visits in a medical office," noted coauthor Kari Olson, PharmD, a clinical pharmacy specialist at Kaiser Permanente Colorado.
"Engaging patients with tools that make health management more accessible is a critical step in addressing the alarming growth of chronic diseases and associated increase in costs," said Peter Neupert, corporate vice president of the Health Solutions Group at Microsoft. "The preliminary results of this clinical trial are significant and demonstrate how cost-effective and flexible technology solutions can encourage patients to be active partners in their health and help decrease their risk for life-threatening, acute care incidents."
This Kaiser Permanente Colorado research is part of a larger effort at Kaiser Permanente to study remote monitoring and connected telehealth to deliver health care at a distance outside of the traditional health care facilities.
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