Telemonitoring Helps Pharmacists Manage Patients' HypertensionTelemonitoring Helps Pharmacists Manage Patients' Hypertension

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Patients who use a home blood-pressure monitoring device along with pharmacist case management support are more likely to lower their blood pressure (BP) than those who use only a primary care provider, according to research presented recently at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2012.

Investigators came to this conclusion after a six month examination of 450 patients, from 16 primary care clinics, who suffer from uncontrolled high blood pressure. The patients were divided into two groups, with about half assigned to traditional care through their primary care providers and the other half to a primary care provider plus additional management and telemonitoring support from a pharmacist.

The key findings of the study revealed:

-- After six months, 45.2% of participants in the traditional care group and 71.8% in the telemonitoring intervention group had reduced their blood pressure to healthy levels: under 140/90 mm Hg in most patients, and under 130/80 mm Hg in those with diabetes or kidney disease.

-- At the start of the study, all patients' blood pressures averaged 148/85 mm Hg. At six months, the average was 126/76 mm Hg in the telemonitoring group and 138/82 mm Hg in the traditional care group.

-- Patients in the telemonitoring group received more high blood pressure medication after six months than patients in the traditional care group.

-- Patients in the telemonitoring group reported that they were better at remembering to consistently take their medications than those in the traditional care group.

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"This study showed large improvements in BP control and an 11/6 mm Hg improvement in blood pressure in the telemonitoring intervention group compared to the usual care group at the 6-month time point," Karen Margolis, the study's lead author, told information Healthcare.

The study's authors noted that the electronic exchange of medical information between two sites at different locations is a promising tool for managing chronic conditions. Previous research shows that patients with high blood pressure visit a physician an average of 4 times or more per year in the U.S., but BP comes under control in fewer than half of these patients. Margolis and her colleagues believe telemedicine can do better.

With this in mind, the researchers designed a model that provides telemonitoring intervention in which patients received an A&D Medical blood pressure monitor that stores and transmits BP data through a touchtone or cellular phone modem to a secure website.

Pharmacists review that data to determine whether patients need to change their medication regime. The pharmacist case managers work directly with patients under a collaborative practice agreement with the clinics' primary care teams and meet with patients at the clinic and discuss all changes to treatment during telephone visits.

Part of the telephone service also includes a computer system that automatically calls and asks the patient two questions once he or she has sent his data to the website: "Have you missed more than one dose of your blood pressure medication in the past week?" and "Are you having any problems that you would like your study pharmacist to call you about before your next regularly scheduled call?"

A 'yes' answer to either question generates an automatic e-mail alert from the website to the pharmacist. Patients can request the pharmacist to contact them each time they transmit BP data. Pharmacists also receive automatic e-mail alerts if the patient has a dangerously high (≥180/110 mmHg) or low (below 80/50 mmHg) reading.

Since the study lasted only 6 months, HealthPartners Medical Group (HPMG), a multi-specialty practice in the Minneapolis-St. Paul metropolitan area where all 450 patients had their blood pressure measured at the beginning of the study, plans to analyze patient data at 12 months and 18 months to determine the long-term effects of the intervention.

"If these results at 6 months are sustained at the 12-month time-point and are maintained at 18 months after the patients return to the care of their primary physician, this would be one of the most effective methods to improve uncontrolled hypertension," Margolis added.

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