From the 2021 HVPAA National Conference
Niraj Madhani (UTSW), Sandeep Das (Parkland), Kristin Alvarez, Sheryl Mathew, Jacqueline Jones
Background
Logistic impacts of the COVID-19 pandemic have catalyzed changes in US health care delivery, including the movement of traditionally office-based care to the home, including for hypertension. Hypertension is common in the safety net health systems setting. However, the feasibility of home-based blood pressure (HBP) monitoring in the context of poor health literacy and reduced access to health technology is unclear. Most prior studies evaluating the use of home cuffs have also involved scheduled office visits and check ins, making it difficult to evaluate the effect of HBP monitoring in patients with limited resources and without the structure of a clinical trial. Moving hypertension care outside the clinic could offer significant post-pandemic advantages in this population, in terms of improved access and decreased cost of care.
Objective
This pilot project aims to assess the feasibility of home blood pressure monitoring without routine in person office visits.
Methods
61 patients with a scheduled upcoming visit in Parkland Hospital’s hypertension clinic agreed to being mailed arm cuffs, instructions, logbooks, and pamphlets about hypertension in March and April 2020. Follow up was as per patients’ own providers but was largely virtual over this time period. Charts were reviewed for blood pressure and other data. Out of 61 patients, 14 had office blood pressures available 6 months prior to and after March and had not previously established care in hypertension clinic until after receiving the blood pressure cuff. 14 patients were a part of the control group as they met the above criteria and were confirmed not to have home cuffs.
Results
Our study showed a reduction in average systolic blood pressure in both the intervention and control groups (163 to 147 vs. 158 to 153 mmHg, respectively). Diastolic blood pressure also decreased in the intervention and control groups (88 to 79 vs 80 to 79 mmHg, respectively). The intervention group had a higher average weight (114 vs 87 kg), lower percentage of women (64% vs 79%), and a lower average age (59 vs 65). Both groups had zero hypertension clinic visits prior to the intervention, with an average of 18 visits in the intervention and 21 in the control group in the post period. Both groups had more virtual visits than in person visits. Although number of medications did not change in either group, the control group had more patients with dosage increases (57% vs. 43%) while the intervention group had more with a new medication (86% vs. 64%).
Conclusions
This pilot study showed feasibility of home-based BP monitoring and telephonic management in a safety net health system outside the structured setting of a clinical trial.
Clinical Implications
Although underpowered for clinical outcomes, this study provides a proof-in-concept that mailed BP cuffs and telephone check-ins are a feasible alternative to regular clinic visits. If confirmed in a larger study, this has important implications for hypertension care in resource limited settings, obviating the need to pay for transportation or office visits and improving ease of access. Future studies of effectiveness and cost impact are warranted.
