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Tran KC, Mak M, Kuyper LM, Bittman J, Mangat B, Lindsay H, Kim Sing C, Xu L, Wong H, Dawes M, Khan N, Ho K. Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study. JMIR Form Res 2024; 8:e49592. [PMID: 38111177 PMCID: PMC10865197 DOI: 10.2196/49592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. OBJECTIVE Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. METHODS Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. RESULTS A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by -13/-5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. CONCLUSIONS HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Meagan Mak
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura M Kuyper
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jesse Bittman
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Birinder Mangat
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Lindsay
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Liang Xu
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Hubert Wong
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Martin Dawes
- Division of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Khan
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Kendall Ho
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Vaseekaran M, Kaese S, Görlich D, Wiemer M, Samol A. WATCH-BPM-Comparison of a WATCH-Type Blood Pressure Monitor with a Conventional Ambulatory Blood Pressure Monitor and Auscultatory Sphygmomanometry. SENSORS (BASEL, SWITZERLAND) 2023; 23:8877. [PMID: 37960576 PMCID: PMC10650650 DOI: 10.3390/s23218877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. METHODS Therefore, 159 consecutive patients (84 male, 75 female, mean age 64.33 ± 16.14 years) performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. RESULTS The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was "bad" for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. CONCLUSION The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data.
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Affiliation(s)
- Mathini Vaseekaran
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Sven Kaese
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Münster, 48149 Muenster, Germany;
| | - Marcus Wiemer
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Alexander Samol
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
- Department of Cardiology and Angiology, St. Antonius-Hospital Gronau GmbH, Möllenweg 22, 48599 Gronau, Germany
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Avegno KS, Roberson KB, Onsomu EO, Edwards MF, Dean EL, Bertoni AG. Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5287. [PMID: 37047903 PMCID: PMC10094475 DOI: 10.3390/ijerph20075287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.
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Affiliation(s)
- Komlanvi S. Avegno
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Kristina B. Roberson
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Elijah O. Onsomu
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Michelle F. Edwards
- Triad Adult and Pediatric Medicine, 1002 S. Eugene Street, Greensboro, NC 27406, USA
| | - Eric L. Dean
- Dean Internal Medicine, 1409 Yanceyville St., Ste C, Greensboro, NC 27405, USA
| | - Alain G. Bertoni
- School of Medicine, Wake Forest University, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
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Makarov SA, Smirnov KV, Danilchenko YV. Telemedicine technologies in improving the effectiveness of follow-up monitoring of patients with lower extremity peripheral artery disease during the COVID-19 pandemic. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
Aim. To evaluate the effectiveness of a novel approach to follow-up monitoring of patients with lower extremity peripheral artery disease (PAD) using telemedicine technologies.Material and methods. The study included 175 patients (mean age, 68,1±7,7 years). Two following groups of patients were formed: the main group (n=86), which used an optimized monitoring program using telemedicine techniques, and the control group (n=89), which assumed traditional monitoring by a cardiologist and a vascular surgeon. The mean follow-up period was 11,77±1,5 months. The optimized monitoring program included the implementation of audio communication with patients by an employee with a secondary medical education with an assessment of the current health status according to original unified questionnaire, with the definition of personalized management tactics. At the primary and final stages, the patient underwent an assessment of clinical and anamnestic data, mental and cognitive status, and compliance.Results. At the final stage, uncompensated hypertension was revealed in 36,0% and 49,4% (p=0,0001), smoking — in 30,6% and 42,9% (p=0,05) in the main and control group, respectively. In the main group, a greater pain-free walking distance was revealed — 625,8±395,3 m (control group — 443±417 m (p=0,013)). The average systolic blood pressure was 125,2±10,2 mm Hg and 138,8±15,8 mm Hg (p=0,0001) in the main and control group, respectively. In the control group, a greater number of patients with a high level of personal and situational anxiety were revealed (p=0,05). In the main group, a higher level of adherence to therapy was established at the final study stage (p=0,001).Conclusion. The optimized monitoring program for patients with limited mobility is effective and can be implemented in practical healthcare for patients with lower extremity PAD.
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Affiliation(s)
- S. A. Makarov
- Research Institute of Complex Issues of Cardiovascular Diseases
| | - K. V. Smirnov
- Research Institute of Complex Issues of Cardiovascular Diseases
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Ramos-Zavala MG, Grover-Páez F, Cardona-Muñoz EG, Cardona-Müller D, Alanis-Sánchez AG, Pascoe-González S, Roman-Rojas D, Ramos-Becerra CG, Alvarez-López H, Chávez-Mendoza A, De la Peña-Topete GJ, Enciso-Muñóz JM, Estrada-Suárez A, Galvan-Oseguera H, Guerra-López A, Gutiérrez-Fajardo P, Lupercio-Mora K, Nikos-Christo SN, Palomo-Piñón S, Ruíz-Gastelum E, Velasco-Sánchez RG. Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial. JRSM Cardiovasc Dis 2023; 12:20480040231178585. [PMID: 37346383 PMCID: PMC10280509 DOI: 10.1177/20480040231178585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
Background In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.
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Affiliation(s)
- MG Ramos-Zavala
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - F Grover-Páez
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - EG Cardona-Muñoz
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - D Cardona-Müller
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - AG Alanis-Sánchez
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - S Pascoe-González
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - D Roman-Rojas
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - CG Ramos-Becerra
- Instituto de Terapéutica Experimental y
Clínica, Laboratorio de Mecánica Vascular, Departamento de Fisiología, Centro
Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara,
Jalisco, Mexico
| | - H Alvarez-López
- Hospital de Especialidades Puerta de
Hierro, Guadalajara, Jalisco, México
| | | | - A Chávez-Mendoza
- Hospital de Cardiología del CMN Siglo
XXI of the Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - H Galvan-Oseguera
- Hospital de Cardiología del CMN Siglo
XXI of the Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - P Gutiérrez-Fajardo
- Hospital de Especialidades San
Francisco de Asís, Guadalajara, Jalisco, México
| | - K Lupercio-Mora
- Hospital de Cardiología del CMN Siglo
XXI of the Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - SN Nikos-Christo
- Centro de Investigación y Atención
Especializada, Veracruz, Veracruz, México
| | - S Palomo-Piñón
- CE U. Investigación Médica en
Enfermedades Nefrológicas CMN Siglo XXI del IMSS, Ciudad de México, México
| | - E Ruíz-Gastelum
- Clínica de Hipertensión y Riesgo
Cardiovascular (ISSSTESON), Hermosillo, Sonora, México
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Karam S, Drawz PE. Telemonitoring for Hypertension Management: The Time Is Now. KIDNEY360 2022; 3:1961-1964. [PMID: 36514394 PMCID: PMC9717640 DOI: 10.34067/kid.0001302022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/15/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Paul E. Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
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Zhu L, Li D, Jiang XL, Jia Y, Liu Y, Li F, Chen X, Lin T, Diao D, Gao Y. Effects of telemedicine interventions on essential hypertension: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060376. [PMID: 36175096 PMCID: PMC9528584 DOI: 10.1136/bmjopen-2021-060376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Essential hypertension is a major preventable risk factor for early cardiovascular disease, premature death and disability. It has been reported that telemedicine interventions can provide an innovative solution to essential hypertension to overcome the barriers that exist in traditional treatment or control. Nevertheless, this subject has not been thoroughly investigated. The goal of this study is to systematically evaluate and describe the impact of telemedicine interventions on essential hypertension. METHODS AND ANALYSIS To find relevant research, we will conduct a systematic literature search of three databases (PubMed, Embase and Cochrane Library), with no language limitations, in addition to researching grey literature. Two reviewers will extract the data individually, and any disagreements will be resolved by discussion or by a third reviewer. The randomised controlled trials will be chosen based on predetermined inclusion criteria. Primary outcomes will include systolic blood pressure and diastolic blood pressure after the telemedicine intervention. Secondary outcomes will include medication adherence (eg, the Morisky Medication Adherence Questionnaire), quality of life (eg, the MOS item scale of the Health Survey Short Form 36 questionnaire), blood pressure control rate and adverse events (eg, stroke, chronic renal failure, aortic dissection, myocardial infarction and heart failure). The quality of the included studies will be assessed using the Cochrane risk-of-bias method. The data will be analysed using RevMan V.5.3.5 software and STATA V.16.0 software. If heterogeneity testing reveals little or no statistical heterogeneity, a fixed effect model will be used for data synthesis; otherwise, a random effect model would be employed. We will synthesise the available evidence to perform a high-quality meta-analysis. ETHICS AND DISSEMINATION This project does not require ethical approval because it will be conducted using publicly available documents. The review's findings will be published in peer-reviewed journals and publications. PROSPERO REGISTRATION NUMBER CRD42021293539.
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Affiliation(s)
- Ling Zhu
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Dongze Li
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiao-Lian Jiang
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Yu Jia
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Liu
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Fanghui Li
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiaoli Chen
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Tao Lin
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Dongmei Diao
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yongli Gao
- Emergency Department of West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
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Xue Q, Zhang X, Liu R, Guan X, Li G, Zhao L, Wang Q, Wang D, Shen X. Differentiated effects and determinants of home blood pressure telemonitoring: lessons from a three-year cohort in Anhui Jieshou, China. J Med Internet Res 2022; 24:e37648. [PMID: 36114000 DOI: 10.2196/37648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 month) effects of HBPT with little data about its uptake. OBJECTIVE This study aims to explore 3-year use and determinants of HBPT and its interactions with systolic and diastolic blood pressure (SBP/DBP) and blood pressure (BP) control rate. METHODS The study used HBPT records from a 3-year cohort of 5658 hypertensive patients in Anhui Jieshou, China and data from a structured household survey of a random sample (n=3005) from the cohort. The data analysis comprised: calculation and presentation, in time-line trajectories, rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and multivariable linear, logistics and percentile regression analysis using SBP/DBP, BP control rate and yearly times of HBPT as the dependent variable respectively. RESULTS HBPT followed mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from -43 to +39 mmHg for SBP and -27 to +15 mmHg for DBP. The monthly rates of active HBPT all manifested a rapid and then slower and slower decline. When controlled for commonly researched confounders, times of HBPT in the last year were found with decreasing correlation coefficients for SBP/DBP (being decreased from 0.10 to -0.35 and from 0.11 to -0.35 respectively) and for BP control rate (from 0.53 to -0.62). CONCLUSIONS HBPT had major and "target-converging" effects on SBP/DBP. The magnitude of changes was much greater than have commonly reported. BP, variation in BP and time were the most important determinants of HBPT uptake; while age, education, duration of hypertension, family history and diagnosis of hypertension complications were also linked to the uptake but at apparently weaker strength. There is a clear need for differentiated thinking over application and assessment of HBPT and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs.
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Affiliation(s)
- Qun Xue
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | | | - Rong Liu
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Xiaoqin Guan
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Guocheng Li
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Linhai Zhao
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | | | - Debin Wang
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Xingrong Shen
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
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Sung M, He J, Zhou Q, Chen Y, Ji JS, Chen H, Li Z. Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review. J Med Internet Res 2022; 24:e37338. [PMID: 35857364 PMCID: PMC9350822 DOI: 10.2196/37338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. OBJECTIVE We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. METHODS We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. RESULTS We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians' suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. CONCLUSIONS Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries.
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Affiliation(s)
- Meekang Sung
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Jinyu He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haotian Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute for Healthy China, Tsinghua Universtiy, Beijing, China
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10
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Muneer S, Okpechi IG, Ye F, Zaidi D, Tinwala MM, Hamonic LN, Ghimire A, Sultana N, Slabu D, Khan M, Braam B, Jindal K, Klarenbach S, Padwal R, Ringrose J, Scott-Douglas N, Shojai S, Thompson S, Bello AK. Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2022; 9:20543581221106248. [PMID: 35756330 PMCID: PMC9218433 DOI: 10.1177/20543581221106248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD. Objective: To determine the impact of HBPT on cardiovascular–related and kidney disease–related outcomes in patients with CKD. Design: Systematic review and meta-analysis. Setting: All studies that met our criteria regardless of country of origin. Participants: Patients with chronic kidney disease included in studies using HBPT for BP assessment and control. Measurements: Descriptive and quantitative analysis of our primary and secondary outcomes. Methods: We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and gray literature from inception for observational and randomized controlled studies in nondialysis (ND) CKD using HBPT for BP control. We selected studies that used HBPT as intervention (with or without a control arm) for BP control in ND-CKD populations. The primary outcome was change in mean systolic BP (SBP) and mean diastolic BP (DBP). Results: We selected 7 studies from 1669 articles that were initially identified. Overall, pooled estimates in the mean difference (MD) for SBP and DBP were −8.8 mm Hg; 95% confidence interval (CI): −16.2 to −1.4; P = .02 and −2.4 mm Hg; 95% CI: −3.8 to −1.0; P < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was −8.0 mm Hg (P = .02) with no significant reduction for DBP (−2.6 mm Hg; P = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced (P > .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m2; P < .001). Limitations: Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement. Conclusion: Home blood pressure telemonitoring is associated with mild lowering of BP and moderately improved kidney function in patients with CKD. However, larger studies with improved designs and prolonged interventions are still needed to assess the effects of HBPT on patients’ outcomes. PROSPERO registration ID CRD42020190705
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Affiliation(s)
- Shezel Muneer
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Laura N Hamonic
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Anukul Ghimire
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Naima Sultana
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dan Slabu
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kailash Jindal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | | | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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11
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Sánchez Peinador C, Torras Borrell J, Castillo Moraga MJ, Egocheaga Cabello MI, Rodríguez Villalón X, Turégano Yedro M, Gamarra Ortiz J, Domínguez Sardiña M, Pallarés Carratalá V. [Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study]. Aten Primaria 2022; 54:102353. [PMID: 35588550 PMCID: PMC9119825 DOI: 10.1016/j.aprim.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo Representantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos. Materiales y métodos Estudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores. Resultados Un total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤ 135/85 mmHg se recomienda pautar una nueva cita telemática en 3-6 meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥ 135/85 mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma. Conclusiones La teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.
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Affiliation(s)
- Carmen Sánchez Peinador
- Centro de Salud Cantalejo, Cantalejo, Segovia, España; Grupo de Trabajo de ECV de SEMG, España
| | - Joan Torras Borrell
- CAP Sant Llàtzer, Terrassa, Barcelona, España; Coordinador del grupo de HTA de la Societat Catalana de Medicina Familiar i Comunitària, CAMFIC, España; Grupo de Trabajo de HTA de SEMFYC, España.
| | - María José Castillo Moraga
- Centro de Salud Sanlúcar Barrio Bajo, Sanlúcar de Barrameda, Cádiz, España; Grupo de Trabajo de HTA y ECV de SEMERGEN, España
| | | | | | - Miguel Turégano Yedro
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Centro de Salud Aldea Moret, Cáceres, España
| | - Javier Gamarra Ortiz
- Grupo de Trabajo de ECV de SEMG, España; CS Medina Rural, Medina del Campo, Valladolid, España
| | | | - Vicente Pallarés Carratalá
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
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12
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Telemedicine application in patients with chronic disease: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2022; 22:105. [PMID: 35440082 PMCID: PMC9017076 DOI: 10.1186/s12911-022-01845-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
Background Telemedicine has been widely used for long-term care and self-management in patients with chronic disease, but there is no consensus regarding the effect of telemedicine on chronic disease management. The aim of this study is to review and analyse the effect of telemedicine on the management of chronic diseases such as hypertension, diabetes, and rheumatoid arthritis using a systematic review and meta-analysis. Methods We performed a comprehensive literature search of the Web of Science, PubMed, MEDLINE, EMBASE, CNKI (Chinese database), VIP (Chinese database), WanFang (Chinese database), and SinoMed (Chinese database) databases from their inception until December 31, 2021. The retrieved literature was screened and assessed independently by two authors. We used the risk-of-bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2 for assessing literature quality and Revman 5.3 software to conduct the meta-analysis. Results Fifteen articles were included in this study. The results of the systematic review indicated that telemedicine consultation and telemonitoring are the most commonly used intervention methods. Telemedicine is helpful for improving self-management in patients with rheumatoid arthritis. The results of the meta-analysis showed patients’ index of glycosylated hemoglobin (HbA1c) improved after 12 months of intervention (MD = − 0.84; 95% CI = − 1.53, − 0.16; Z = 2.42; P = 0.02), and no significant differences in fasting blood glucose (FBG) levels were observed after 6 months of intervention (MD = − 0.35; 95% CI = − 0.75,0.06; Z = 1.69; P = 0.09). The results also showed that systolic blood pressure (MD = − 6.71; 95% CI = − 11.40, − 2.02; Z = 2.81; P = 0.005) was reduced after 6 months of intervention. Conclusion Telemedicine had a positive effect on the management of diabetes, hypertension, and rheumatoid arthritis, especially when telemedicine consultation and telemonitoring method were used. When telemedicine was used as a disease management tool for patients with diabetes, the optimal intervention time is 12 months. Telemedicine improved the systolic blood pressure in hypertensive patients while also reducing negative emotions and enhancing medication adherence in rheumatoid arthritis patients.
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13
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Khanijahani A, Akinci N, Quitiquit E. A Systematic Review of the Role of Telemedicine in Blood Pressure Control: Focus on Patient Engagement. Curr Hypertens Rep 2022; 24:247-258. [PMID: 35412188 PMCID: PMC9003157 DOI: 10.1007/s11906-022-01186-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 12/01/2022]
Abstract
Purpose of Review To systematically review and synthesize the existing evidence on the effects of different telemedicine interventions on improving patient engagement among patients with hypertension. Patient engagement is defined as patients’ knowledge, skills, ability, and willingness to manage their healthcare within the context of interventions designed to promote positive patient behaviors. Recent Findings Telemedicine is a rapidly growing method of healthcare services delivery. Telemedicine interventions are mainly used to facilitate communication between the patient and provider, measure, record, and track blood pressure, and educate and train patients about managing their blood pressure. Findings from several studies indicate the evidence of patient engagement, adherence to the care plan, improvement in knowledge about blood pressure, and patient satisfaction with telemedicine interventions for blood pressure. Summary Telemedicine interventions need to be customized depending on patient demographics and socioeconomic characteristics such as age and education level to ensure optimal patient engagement. Supplementary Information The online version contains supplementary material available at 10.1007/s11906-022-01186-5.
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
| | - Nesli Akinci
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Eric Quitiquit
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
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14
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Naqvi IA, Cheung YK, Strobino K, Li H, Tom SE, Husaini Z, Williams OA, Marshall RS, Arcia A, Kronish IM, Elkind MSV. TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting. Pilot Feasibility Stud 2022; 8:81. [PMID: 35410312 PMCID: PMC8995696 DOI: 10.1186/s40814-022-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension is the most important modifiable risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, hypertension remains poorly controlled in many stroke survivors. Black and Hispanic patients have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access to care contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) is a telehealth intervention that integrates remote BP monitoring (RBPM) including nursing telephone support, tailored BP infographics and telehealth video visits with a multidisciplinary team approach including pharmacy to improve post-stroke care and reduce stroke disparities. Methods In this pilot trial, 50 acute stroke patients with hypertension will be screened for inclusion prior to hospital discharge and randomized to usual care or TASC. Usual care patients will be seen by a primary care nurse practitioner at 1–2 weeks and a stroke neurologist at 1 and 3 months. In addition to these usual care visits, TASC intervention patients will see a pharmacist at 4 and 8 weeks and will be enrolled in RBPM consisting of home BP monitoring with interval calls by a centralized team of telehealth nurses. As part of RBPM, TASC patients will be provided with a home BP monitoring device and electronic tablet that wirelessly transmits home BP data to the electronic health record. They will also receive tailored BP infographics that help explain their BP readings. The primary outcome will be feasibility including recruitment, adherence to at least one video visit and retention rates. The clinical outcome for consideration in a subsequent trial will be within-patient change in BP from baseline to 3 months after discharge. Secondary outcomes will be medication adherence self-efficacy and satisfaction with post-stroke telehealth, both measured at 3 months. Additional patient reported outcomes will include depression, cognitive function, and socioeconomic determinants. Multidisciplinary team competency and fidelity measures will also be assessed. Conclusions Integrated team-based interventions may improve BP control and reduce racial/ethnic disparities in post-stroke care. TASC is a post-acute stroke care model that is novel in providing RBPM with tailored infographics, and a multidisciplinary team approach including pharmacy. Our pilot will determine if such an approach is feasible and effective in enhancing post-stroke BP control and promoting self-efficacy. Trial registration ClinicalTrials.gov NCT04640519 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01025-z.
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Affiliation(s)
- Imama A Naqvi
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Division of Stroke and Cerebrovascular Diseases, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kevin Strobino
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hanlin Li
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sarah E Tom
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Olajide A Williams
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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Citoni B, Figliuzzi I, Presta V, Volpe M, Tocci G. Home Blood Pressure and Telemedicine: A Modern Approach for Managing Hypertension During and After COVID-19 Pandemic. High Blood Press Cardiovasc Prev 2022; 29:1-14. [PMID: 34855154 PMCID: PMC8638231 DOI: 10.1007/s40292-021-00492-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertension is the most common cardiovascular risk factor for acute cardiovascular outcomes, including acute coronary disease, stroke, chronic kidney disease and congestive heart failure. Despite the fact that it represents the most prevalent risk factor in the general population, mostly in elderly individuals, its awareness is still relatively low, being about one third of patients living with undiagnosed hypertension and high risk of experiencing acute cardiovascular events. In addition, though recent improvement in pharmacological and non-pharmacological therapeutic options, hypertension is largely uncontrolled, with about 35-40% of treated hypertensive patients achieving the recommended therapeutic targets. Among different modern interventions proposed for improving blood pressure control in treated hypertensive patients, a systematic adoption of home BP monitoring has demonstrated to be one of the most effective. Indeed, it improves patients' awareness of the disease and adherence to prescribed medications and allows tailoring and personalizing BP lowering therapies. Home BP monitoring is particularly suitable for telemedicine and mobile-health solutions. Indeed, in specific conditions, when face-to-face interactions between patients and physicians are not allowed or even suspended, as in case of COVID-19 pandemic, telemedicine may ensure effective management of hypertension, as well as other cardiovascular and non-cardiovascular comorbidities. This review will summarize strengths and limitations of telemedicine in the clinical management of hypertension with a particular focus on the lessons learned during the COVID-19 pandemic.
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Affiliation(s)
- Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Vivianne Presta
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy.
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16
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Chukwu CA, Rao A, Kalra PA, Middleton R. Managing recurrent urinary tract infections in kidney transplant recipients using smartphone assisted urinalysis test. J Ren Care 2021; 48:119-127. [PMID: 34791800 DOI: 10.1111/jorc.12405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Urinary tract infection is the most frequent infectious complication in allograft recipients with poor outcomes. The study aimed to assess the effect of self-testing urine dipsticks at home, with the assistance of smartphone technology, on the occurrence of urinary tract infection (UTI)-associated complications and frequency and length of hospital admissions. METHOD We performed a retrospective cohort study of kidney transplant recipients with a history of recurrent UTI who used a newly introduced smartphone-assisted dipsticks urinalysis test for self-monitoring. Participants self-administered the home urinalysis test with symptom onset. Antibiotics were prescribed if an infection was suspected, and home urinalysis was positive. The incidence of urinary infections, hospitalisations, and complications was evaluated before and during the home urinalysis period. Remote and face-to-face interactions with healthcare personnel were also assessed (cases acted as their controls). RESULTS Nineteen participants were included in the study. A total of 89.5% were females. Ninety home urinalysis tests were conducted over a mean period of 7 months. Sixty-one of these were pre-antibiotic. A total of 42.2% of all tests and 47.5% of the pre-antibiotic tests were positive. UTI-related hospitalisations were lower by 75% during the home urinalysis period; mean 1.26 (0.8-1.6) versus 0.32 (-0.01-0.6). The incidence of infection-related complications was also 65% lower; mean 1.52 (0.8-2.2) versus 0.52 (-0.2-1.2) during the same period. The number of face-to-face interactions was slightly lower; mean 1.9 (1.1-2.2) versus 1.7 (0.6-2.8), with more remote interactions; mean 6.0 (3.7-8.5) versus 10.4 (6.5-14.3), during smartphone urinalysis. Fifty per cent of antibiotic-treated UTI episodes had antibiotics within 24 h, rising to 82% within 48 h of a test. CONCLUSION Smartphone-assisted home urinalysis enabled remote management of UTI in a high-risk population. Outcomes point to a reduction in UTI complications and hospitalisations.
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Affiliation(s)
- Chukwuma A Chukwu
- Department of Nephrology, Salford Royal Hospital NHS Trust, Salford, UK
| | - Anirudh Rao
- Department of Nephrology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Phillip A Kalra
- Department of Nephrology, Salford Royal Hospital NHS Trust, Salford, UK
| | - Rachel Middleton
- Department of Nephrology, Salford Royal Hospital NHS Trust, Salford, UK
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17
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Gijón-Conde T, Rubio E, Gorostidi M, Vinyoles E, Armario P, Rodilla E, Segura J, Divisón-Garrote JA, García-Donaire JA, Molinero A, Ruilope LM. 2021 Spanish Society of Hypertension position statement about telemedicine. HIPERTENSION Y RIESGO VASCULAR 2021; 38:186-196. [PMID: 33888438 PMCID: PMC8054212 DOI: 10.1016/j.hipert.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/01/2022]
Abstract
The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Cerro del Aire, Departamento de Medicina, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Majadahonda, Madrid, Spain.
| | - E Rubio
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Universidad de Oviedo, Oviedo, Spain
| | - E Vinyoles
- Centre d'Atenció Primària La Mina, Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - P Armario
- Área Atención Integrada de Riesgo Vascular, Departamento de Medicina Interna, Hospital Moisès Broggi Sant Joan Despi, Universidad de Barcelona, Sant Joan Despí, Barcelona, Spain
| | - E Rodilla
- Servicio de Medicina Interna, Hospital Universitario de Sagunto, Universidad Cardenal Herrera-CEU, Sagunto, Valencia, Spain
| | - J Segura
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Divisón-Garrote
- Centro de Salud de Casas Ibáñez, Universidad Católica San Antonio, Casas Ibáñez, Albacete, Spain
| | | | - A Molinero
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | - L M Ruilope
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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18
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Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O’Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, Mancia G. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J Hypertens 2021; 39:1742-1767. [PMID: 34269334 PMCID: PMC9904446 DOI: 10.1097/hjh.0000000000002922] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Cristina Giannattasio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology IV, ‘A. De Gasperis” Department, ASTT GOM Niguarda Ca’ Granda
| | - Philippe Gosse
- Cardiology/Hypertension Unit Saint André Hospital. University Hospital of Borfeaux, France
| | - Geoffrey Head
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Anastasia S. Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paul Muntner
- Hypertension Research Center, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Myers
- Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Teemu Niiranen
- Department of Medicine, Turku University Hospital and University of Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - José Andres Octavio
- Experimental Cardiology, Department of Tropical Medicine Institute, Universidad Central de Venezuela, Venezuela
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paul Padfield
- Department of Medical Sciences, University of Edinburgh, Edinburgh, UK
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit, University Hospital, Fundacion Favaloro, Argentina
| | - James E. Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Egle Silva
- Research Institute of Cardiovascular Diseases of the University of Zulia, Venezuelan Foundation of Arterial Hypertension. Maracaibo, Venezuela
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Paris-Descartes University, AP-HP, Hotel Dieu, Paris, France
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Ji Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael A. Weber
- Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, New York, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Lousiana
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Dorr DA, D'Autremont C, Pizzimenti C, Weiskopf N, Rope R, Kassakian S, Richardson JE, McClure R, Eisenberg F. Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis. Appl Clin Inform 2021; 12:710-720. [PMID: 34348408 DOI: 10.1055/s-0041-1732401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools. METHODS We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS. RESULTS We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9-11.2%), low exclusion (0-0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting. DISCUSSION Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases. CONCLUSION Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.
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Affiliation(s)
- David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Christopher D'Autremont
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Christie Pizzimenti
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Robert Rope
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Steven Kassakian
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | | | - Rob McClure
- MD Partners, Lafayette, Colorado, United States
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20
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Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses. NPJ Digit Med 2021; 4:114. [PMID: 34294852 PMCID: PMC8298448 DOI: 10.1038/s41746-021-00486-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = -4.10, 95% CI: [-6.38, -1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.
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21
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Bilger M, Koong AYL, Phoon IKY, Tan NC, Bahadin J, Bairavi J, Batcagan-Abueg APM, Finkelstein EA. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27496. [PMID: 34106085 PMCID: PMC8262550 DOI: 10.2196/27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID) DERR1-10.2196/27496
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Affiliation(s)
- Marcel Bilger
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria, Austria
| | | | | | | | - Juliana Bahadin
- Saudara Clinic by A+J General Physicians, Singapore, Singapore
| | - Joann Bairavi
- Heath Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Eric A Finkelstein
- Heath Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, United States
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22
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Okpechi IG, Muneer S, Tinwala MM, Zaidi D, Hamonic LN, Braam B, Jindal K, Klarenbach S, Padwal RS, Shojai S, Thompson S, Bello AK. Impact of home telemonitoring and management support on blood pressure control in non-dialysis CKD: a systematic review protocol. BMJ Open 2021; 11:e044195. [PMID: 34035096 PMCID: PMC8154939 DOI: 10.1136/bmjopen-2020-044195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hypertension is a common public health problem and a key modifiable risk factor for cardiovascular (CV) and chronic kidney disease (CKD). Home blood pressure (BP) telemonitoring (HBPT) and management is associated with improved BP control, accelerated delivery of care and decision-making strategies that can reduce adverse outcomes associated with hypertension. The aim of this paper is to describe the protocol for a systematic review to assess the impact of HBPT interventions used for improving BP control and reducing CV and kidney outcomes in non-dialysis CKD patients. METHODS We developed this protocol using the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015. We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO and grey literature for studies conducted in non-dialysis CKD patients on interventions using HBPT and reporting outcomes related to BP control and other outcomes such as CV events and kidney disease progression. All studies meeting these criteria, in adults and published from inception until 2020 with no language barrier will be included. ETHICS AND DISSEMINATION Ethical approval will not be required for this review as the data used will be extracted from already published studies with publicly accessible data. As this study will assess the impact of HBPT on BP control in non-dialysis CKD patients, evidence gathered through it will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations and a report. We will also disseminate our findings to appropriate government agencies. PROSPERO REGISTRATION NUMBER CRD42020190705).
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Division of Nephrology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shezel Muneer
- Division of Nephrology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M Tinwala
- Division of Nephrology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Laura N Hamonic
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Nephrology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Scott Klarenbach
- Division of Nephrology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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23
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Markwei M, Goje O. Optimizing mother-baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine. ACTA ACUST UNITED AC 2021; 17:17455065211013262. [PMID: 33926323 PMCID: PMC8111547 DOI: 10.1177/17455065211013262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.
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Affiliation(s)
- Metabel Markwei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Oluwatosin Goje
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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24
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Pharmacist-Directed Self-Management of Blood Pressure Versus Conventional Management in Patients with Hypertension: A Randomized Control Trial. High Blood Press Cardiovasc Prev 2021; 28:283-290. [PMID: 33765257 DOI: 10.1007/s40292-021-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Data has shown that pharmacist-directed health services play a key role in the treatment of hypertension. AIM We aimed to perform this study to compare two methods of the pharmacist-directed home blood pressure monitoring (HBPM) and the usual care. METHODS A total of 126 patients with uncontrolled blood pressure (BP) were randomized 1:1 into the pharmacist-directed HBPM and the usual care groups. In the intervention group, the patients were trained to measure their BPs and adjust their medications based on the designed protocol under the supervision of a clinical pharmacist. The primary endpoint of the study was the comparison of the BPs at baseline and months 1, 3, and 6. RESULTS One month after the allocation, the baseline systolic BP (SBP) (150.5 ± 13.1 vs. 149.7 ± 11.2 mm Hg; P = 0.71) and diastolic BP (DBP) (97.2 ± 9.8 vs. 93.6 ± 14.5; P = 0.11) significantly dropped to the control range equally in 85.2% of the patients in two groups (SBP: 128.8 ± 6.4 vs. 125.6 ± 7.1 mm Hg; P = 0.01 and DBP: 89.1 ± 6.2 vs. 81.5 ± 6.0 mm Hg; P = 0.01). This pattern continued during the study period (month 6; SBP: 115.6 ± 10.1vs. 116.1 ± 9.6 mm Hg; P = 0.78; DBP: 79.0 ± 5.0 vs. 77.2 ± 5.8 mm Hg; P = 0.08). CONCLUSIONS In this study, we did not observe any significant difference between the pharmacist-directed HBPM and usual care methods in decreasing BP.
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25
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Shen X, Xiao S, Liu R, Tong G, Liu T, Wang D. Personalized hypertension management based on serial assessment and telemedicine (PHMA): a cluster randomize controlled trial protocol in Anhui, China. BMC Cardiovasc Disord 2021; 21:135. [PMID: 33711941 PMCID: PMC7953659 DOI: 10.1186/s12872-021-01943-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite tremendous investment worldwide, hypertension treatment and control rates remain low. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient's dynamic complications and contexts. METHODS/DESIGN PHMA strives to reduce hypertension harms by eight "objective behaviors" (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors. DISCUSSION PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making. Trial registration ISRCTN10999269. July 17, 2020; https://doi.org/10.1186/ISRCTN10999269 .
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Affiliation(s)
- Xingrong Shen
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Siyi Xiao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Rong Liu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Guixian Tong
- The First Affiliated Hospital of USTC, 17 Lujiang Road, Hefei, China
| | - Tongzhu Liu
- The First Affiliated Hospital of USTC, 17 Lujiang Road, Hefei, China
| | - Debin Wang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
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26
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Regelmann MO, Conroy R, Gourgari E, Gupta A, Guttmann-Bauman I, Heksch R, Kamboj MK, Krishnan S, Lahoti A, Matlock K. Pediatric Endocrinology in the Time of COVID-19: Considerations for the Rapid Implementation of Telemedicine and Management of Pediatric Endocrine Conditions. Horm Res Paediatr 2021; 93:343-350. [PMID: 33486483 PMCID: PMC7900478 DOI: 10.1159/000513060] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pediatric endocrine practices had to rapidly transition to telemedicine care at the onset of the novel coronavirus disease 2019 (COVID-19) pandemic. For many, it was an abrupt introduction to providing virtual healthcare, with concerns related to quality of patient care, patient privacy, productivity, and compensation, as workflows had to change. SUMMARY The review summarizes the common adaptations for telemedicine during the pandemic with respect to the practice of pediatric endocrinology and discusses the benefits and potential barriers to telemedicine. Key Messages: With adjustments to practice, telemedicine has allowed providers to deliver care to their patients during the COVID-19 pandemic. The broader implementation of telemedicine in pediatric endocrinology practice has the potential for expanding patient access. Research assessing the impact of telemedicine on patient care outcomes in those with pediatric endocrinology conditions will be necessary to justify its continued use beyond the COVID-19 pandemic.
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Affiliation(s)
- Molly O. Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital at Montefiore, Albert Einstein School of Medicine, Bronx, New York, USA,*Molly O. Regelmann, Division of Pediatric Endocrinology, Children's Hospital at Montefiore, 3415 Bainbridge Ave., Bronx NY 10467 (USA),
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital, Springfield, Massachusetts, USA
| | - Evgenia Gourgari
- Division of Pediatric Endocrinology, Georgetown University, Washington, District of Columbia, USA
| | - Anshu Gupta
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ines Guttmann-Bauman
- Division of Pediatric Endocrinology, Department of Pediatrics, OHSU (Oregon Health and Science University), Portland, Oregon, USA
| | - Ryan Heksch
- Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA
| | - Manmohan K. Kamboj
- Division of Pediatric Endocrinology, Nationwide Children's Hospital at The Ohio State University, Columbus, Ohio, USA
| | - Sowmya Krishnan
- Division of Pediatric Diabetes and Endocrinology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Amit Lahoti
- Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristal Matlock
- Division of Pediatric Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
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Ionov MV, Zhukova OV, Zvartau NE, Konradi AO. [Blood pressure telemonitoring and remote counseling in uncontrolled hypertension]. TERAPEVT ARKH 2021; 93:30-40. [PMID: 33720623 DOI: 10.26442/00403660.2021.01.200590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. AIM Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. MATERIALS AND METHODS A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective. RESULTS In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient). CONCLUSION According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.
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Affiliation(s)
- M V Ionov
- Almazov National Medical Research Centre.,National Research University of Information Technologies, Mechanics and Optics
| | | | - N E Zvartau
- Almazov National Medical Research Centre.,National Research University of Information Technologies, Mechanics and Optics
| | - A O Konradi
- Almazov National Medical Research Centre.,National Research University of Information Technologies, Mechanics and Optics
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Hu Y, Wen X, Ni L, Wang F, Hu S, Fang F. Effects of telemedicine intervention on the management of diabetic complications in type 2 diabetes. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00893-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Kraef C, van der Meirschen M, Free C. Digital telemedicine interventions for patients with multimorbidity: a systematic review and meta-analysis. BMJ Open 2020; 10:e036904. [PMID: 33051232 PMCID: PMC7554457 DOI: 10.1136/bmjopen-2020-036904] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/15/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of digital telemedicine interventions designed to improve outcomes in patients with multimorbidity. DESIGN Systematic review and meta-analysis of available literature. DATA SOURCES MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Database of Abstracts of Reviews of Effectiveness and hand searching. The search included articles from inception to 19 April 2019 without language restrictions. The search was updated on 7 June 2020 without additional findings. ELIGIBILITY CRITERIA Prospective interventional studies reporting multimorbid participants employing interventions with at least one digital telemedicine component were included. Primary outcomes were patient physical or mental health outcomes, health-related quality of life scores and the utilisation of health services. RESULTS Out of 5865 studies initially identified, 7 articles, reporting on 6 studies were retained (total of 699 participants). Four of these studies reported interventions including integration with usual care, two studies had interventions with no links to usual patient care. Follow-up periods lasted between 2 and 6 months. Among the studies with links to usual care, the primary outcomes were systolic blood pressure (SBP) (three studies), haemoglobin A1c (HbA1c) (three studies), total cholesterol (two studies) and self-perceived health status (one study). The evidence ranged from very low to moderate certainty. Meta-analysis showed a moderate decrease in SBP (8 mm Hg (95% CI 4.6 to 11.4)), a small to moderate decrease in HbA1c (0.46 mg/dL (95% CI 0.25 to 0.67)) and moderate decrease in total cholesterol (cholesterol 16.5 mg/dL (95% CI 8.1 to 25.0)) in the intervention groups. There was an absence of evidence for self-perceived health status. Among the studies with no links to usual care, time to hospitalisation (median time to hospitalisation 113.4 days intervention and 104.7 days control group, absolute difference 12.7 days) and the Minnesota Living with Heart Failure Questionnaire (intervention group 35.2 score points, control group 23.9 points, absolute difference 11.3, 95% CI 5.5 to 17.1) showed small reductions. The Personal Health Questionnaire (PHQ-8) showed no evidence of improvement (intervention 7.6 points, control 8.6 points, difference 1.0 points, 95% CI -22.9% to 11.9%). CONCLUSION Digital telemedicine interventions provided moderate evidence of improvements in measures of disease control but little evidence and no demonstrated benefits on health status. Further research is needed with clear descriptions of conditions, interventions and outcomes based on patients' and healthcare providers' preferences. PROSPERO REGISTRATION NUMBER CRD42019134872.
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Affiliation(s)
- Christian Kraef
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Marc van der Meirschen
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Free
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Ionov MV, Zhukova OV, Yudina YS, Avdonina NG, Emelyanov IV, Kurapeev DI, Zvartau NE, Konradi AO. Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients. Blood Press 2020; 30:20-30. [PMID: 32954832 DOI: 10.1080/08037051.2020.1813015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.
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Affiliation(s)
- Mikhail V Ionov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Olga V Zhukova
- Ministry of Health of the Russian Federation, Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
| | - Yulia S Yudina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Natalya G Avdonina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Igor V Emelyanov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Dmitri I Kurapeev
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Nadezhda E Zvartau
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Alexandra O Konradi
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
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Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, Logan AG, Magid DJ, Mckinstry B, Margolis KL, Parati G, Wakefield BJ. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension 2020; 76:1368-1383. [PMID: 32921195 DOI: 10.1161/hypertensionaha.120.15873] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.
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Affiliation(s)
- Stefano Omboni
- From the Clinical Research Unit, Italian Institute of Telemedicine, Varese (S.O.).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (R.J.M.)
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, NC (H.B.B.).,Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC.,Division of General Internal Medicine (H.B.B.), Duke University, Durham, NC.,Department of Population Health Sciences (H.B.B.), Duke University, Durham, NC
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, United Kingdom (L.C.C.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.)
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Alexander G Logan
- Department of Medicine, Mount Sinai Hospital, University Health Network and University of Toronto, ON, Canada (A.G.L.)
| | - David J Magid
- Colorado Permanente Medical Group, Denver and School of Public Health, University of Colorado, Aurora (D.J.M.)
| | - Brian Mckinstry
- Emeritus Professor of Primary Care eHealth, Usher Institute, The University of Edinburgh, United Kingdom (B.M.)
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.).,Istituto Auxologico Italiano, IRCCS San Luca, Milano, Italy (G.P.)
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Sadanshiv M, Jeyaseelan L, Kirupakaran H, Sonwani V, Sudarsanam TD. Feasibility of computer-generated telephonic message-based follow-up system among healthcare workers with diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001237. [PMID: 32661193 PMCID: PMC7359061 DOI: 10.1136/bmjdrc-2020-001237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To assess the feasibility of computer-generated educational messaging system in healthcare workers of a tertiary care hospital. The secondary objectives were glycemic control, patient satisfaction and adherence to lifestyle modifications. RESEARCH DESIGN AND METHODS Single-center parallel-group open-labeled randomized controlled trial with computer generated block randomization. SETTING Healthcare workers with diabetes working in Christian Medical College Vellore, Tamil Nadu. PARTICIPANTS 431 assessed, 341 met the selection criteria, 320 participants were randomized and 161 were taken into intervention arm and 159 in the control arm. INTERVENTION Computer-generated short message service (SMS) based on transtheoretical model of behavioral change, 2 messages per week for 3 months, along with standard of care diabetic care. Messages had educational material regarding healthy eating habits and exercise and these messages were sent twice weekly. The messages were scheduled via an automatic calendar in a way that each subject in the intervention arm received 15 educational messages per month.Control group received only standard of care diabetic care which included dietary advice, exercise regimen and diabetic medications under supervision of their physician every 3 months. FOLLOW-UP 6 months. RESULTS 95.65% of people in the intervention arm (n=154) received regular messages, out of which 93.17% read the messages regularly. 80.12% acted on the messages. 93.17% felt more satisfied with their healthcare.While both groups showed improvement in body mass index (BMI) and hemoglobin A1c (HbA1c), the difference was greater in the intervention with regard to both decrease in BMI (-0.6, p<0.001) and HBA1c (-0.48, p<0.001). CONCLUSIONS SMS-based education system is feasible in improving healthcare among healthcare workers with diabetes. It improves patient satisfaction, adherence and improves healthcare among individuals with diabetes by decreasing their BMI and decreasing HbA1c.
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Affiliation(s)
- Mahima Sadanshiv
- General Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Lakshmanan Jeyaseelan
- Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Henry Kirupakaran
- Staff Student Health Service, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - Thambu David Sudarsanam
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring. Curr Hypertens Rep 2020; 22:42. [PMID: 32506273 DOI: 10.1007/s11906-020-01056-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status. RECENT FINDINGS There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and cost-saving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated.
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Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, Barbarash OL, Boitsov SA, Vavilova TV, Villevalde SV, Galyavich AS, Glezer MG, Grineva EN, Grinstein YI, Drapkina OM, Zhernakova YV, Zvartau NE, Kislyak OA, Koziolova NA, Kosmacheva ED, Kotovskaya YV, Libis RA, Lopatin YM, Nebiridze DV, Nedoshivin AO, Ostroumova OD, Oschepkova EV, Ratova LG, Skibitsky VV, Tkacheva ON, Chazova IE, Chesnikova AI, Chumakova GA, Shalnova SA, Shestakova MV, Yakushin SS, Yanishevsky SN. Arterial hypertension in adults. Clinical guidelines 2020. ACTA ACUST UNITED AC 2020. [DOI: 10.15829/1560-4071-2020-3-3786] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Arterial hypertension in adults. Clinical guidelines 2020
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Ambika M, Raghuraman G, SaiRamesh L, Ayyasamy A. Intelligence – based decision support system for diagnosing the incidence of hypertensive type. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2020. [DOI: 10.3233/jifs-190143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Ambika
- Department of Computer Science and Engineering, SSN College of Engineering, Kalavakkam, Chennai, Tamil Nadu, India
| | - G. Raghuraman
- Department of Computer Science and Engineering, SSN College of Engineering, Kalavakkam, Chennai, Tamil Nadu, India
| | - L. SaiRamesh
- Department of Information Science and Technology, CEG, Anna University Chennai, Tamil Nadu, India
| | - A. Ayyasamy
- Department of Computer Science and Engineering, Faculty of Engineering and Technology, Annamalai University, Tamil Nadu, India
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Ionov MV, Zhukova OV, Zvartau NE, Kurapeev DI, Yudina YS, Konradi AO. Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension. TERAPEVT ARKH 2020; 92:49-55. [DOI: 10.26442/00403660.2020.01.000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p
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37
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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Kao CW, Chen TY, Cheng SM, Lin WS, Chang YC. A Web-Based Self-Titration Program to Control Blood Pressure in Patients With Primary Hypertension: Randomized Controlled Trial. J Med Internet Res 2019; 21:e15836. [PMID: 31804186 PMCID: PMC6923762 DOI: 10.2196/15836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/28/2019] [Accepted: 10/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life. OBJECTIVE Our primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life. METHODS This was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention. RESULTS We included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (-21.4 mm Hg and -5.4 mm Hg, respectively; P<.001) and 6 months (-27.8 mm Hg and -9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (-0.202, P=.003) and 6 (-0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001). CONCLUSIONS A Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension. TRIAL REGISTRATION ClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974.
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Affiliation(s)
- Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Yu Chen
- School of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Shiang Lin
- Division of Cardiology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Pan F, Wu H, Liu C, Zhang X, Peng W, Wei X, Gao W. Effects of home telemonitoring on the control of high blood pressure: a randomised control trial in the Fangzhuang Community Health Center, Beijing. Aust J Prim Health 2019; 24:398-403. [PMID: 30131099 DOI: 10.1071/py17187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
Abstract
This study aimed to evaluate the effect of home telemonitoring on the control of high blood pressure in the Fangzhuang Community Health Center in Fengtai District, Beijing. A total of 110 hypertensive patients with uncontrolled high blood pressure were equally allocated to an intervention group and a control group randomly. The participants in the intervention group received home telemonitoring for blood pressure delivered by a team comprising a GP, a hypertension specialist, a general nurse and an information manager. The participants in the control group received the usual care. The levels of systolic and diabolic blood pressure of the participants were assessed on days 0 (baseline), 30, 90 and 180. On average, the intervention group had a greater reduction in blood pressure compared with the control by 6.6-8.0mmHg in systolic blood pressure and 0-3.0mmHg in diastolic blood pressure. Similarly, higher proportions of patients with normal blood pressure were achieved in the intervention group (63.6-71.2%) compared with the control (38.5-41.8%). The reduction in systolic blood pressure for the participants in the intervention group was positively correlated with the utilisation of the app (P<0.05). Home telemonitoring is effective in the control of high blood pressure.
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Affiliation(s)
- Fengying Pan
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
| | - Hao Wu
- Fangzhuang Community Health Center in Fengtai District, Capital Medical University, Beijing, 100078, P.R. China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Xiaolei Zhang
- Fangzhuang Community Health Center in Fengtai District, Capital Medical University, Beijing, 100078, P.R. China
| | - Wei Peng
- Fangzhuang Community Health Center in Fengtai District, Capital Medical University, Beijing, 100078, P.R. China
| | - Xuejuan Wei
- Fangzhuang Community Health Center in Fengtai District, Capital Medical University, Beijing, 100078, P.R. China
| | - Wenjuan Gao
- Fangzhuang Community Health Center in Fengtai District, Capital Medical University, Beijing, 100078, P.R. China
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Omboni S. Connected Health in Hypertension Management. Front Cardiovasc Med 2019; 6:76. [PMID: 31263703 PMCID: PMC6584810 DOI: 10.3389/fcvm.2019.00076] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Abstract
e-health is defined as the use of communication and information technologies (ICT) to manage patients and their health in a more efficient way, with the aim of improving the overall quality of care. Healthcare services relying on telehealth (or telemedicine) and mobile health (m-health) are the most popular e-health tools used by healthcare professionals and consumers. These applications allow the exchange of medical data between patients and their doctors or among healthcare professionals, mainly through the Internet, and are used to provide healthcare services remotely (so-called "connected health"). The most popular telemedicine application in the field of hypertension is blood pressure telemonitoring (BPT), which enables transmission of BP and various clinical information from patients' homes or from the community to the doctor's surgery or the hospital. Numerous randomized controlled trials have documented a significant BP reduction combined with an intensification and optimization of the use of antihypertensive medications in patients making use of BPT plus remote counseling by a case manager, with the supervision of a doctor or a community pharmacist (telepharmacy). The major benefits of BPT are usually observed in high-risk patients. BPT can also be based on m-health wireless solutions, provided with educational support, medication trackers and reminders, and teleconsultation. In this context, BPT may favor patient's self-management, as an adjunct to the doctor's intervention, and foster patient's participation in medical decision making, with consequent improvement in BP control and increase in medication adherence. In conclusion, e-health solutions, and in particular telemedicine, are increasingly attaining a key position in the management of the hypertensive patient, with an enormous potential in terms of improvement of the quality of the delivered care, increase in the chance of a successful BP control and effective prevention of cardiovascular diseases.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russia
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Oleynikov VE, Chizhova OV, Dzhazovskaya IN, Shigotarova EA, Salyamova LI, Tomashevskaya YA, Matrosova IB. ECONOMIC JUSTIFICATION OF THE APPLICATION OF THE AUTOMATIC REMOTE BLOOD PRESSURE MONITORING. ACTA ACUST UNITED AC 2019. [DOI: 10.18821/0044-197x-2019-63-1-14-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Among the priorities of the strategic development of the health care system there is the telemedicine technologies implementation. Material and methods. The project was developed in the Penza State University. For the economic justification of the remote BP monitoring, the project technological scheme has been prepared, the market capacity has been assessed and competition has been analyzed, the business model and financial model of the project have been developed, and risks have been evaluated. Results. The project is deployed at the base and with the participation of the budget medical institution. The patient is provided with a tonometer with built-in GSM or blutooth module. After the patient’s BP has been measured, the data in an encrypted format is transmitted to the remote monitoring center and stored in the cloud base. For each patient, the doctor sets target and individual thresholds for blood pressure. Intermediate monitoring of BP is carried out by paramedical personnel who, in case of deviations from reference values, notify the attending physician. The patient receives feedback in the form of SMS-messages to his mobile phone: time for BP measuring, taking drugs and recommendations for the therapy correction. Payment is carried out according to the approved Mandatory Medical Insurance Fund tariff. Conclusion. The introduction of remote blood pressure monitoring will reduce the cost of providing medical care by reducing the number of hypertension complications, open up prospects for research and development of medical professionals. Fundamentally new conditions will arise for the study of chronopharmacology of antihypertensive drugs in patients with hypertension.
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Kathuria-Prakash N, Moser DK, Alshurafa N, Watson K, Eastwood JA. Young African American women’s participation in an m-Health study in cardiovascular risk reduction: Feasibility, benefits, and barriers. Eur J Cardiovasc Nurs 2019; 18:569-576. [DOI: 10.1177/1474515119850009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Young black women have an increased risk of cardiovascular disease, and thus identifying innovative prevention strategies is essential. A potential preventive strategy is mobile health; however, few studies have tested this strategy in young black women. Aim: The purpose of this study was to assess the feasibility of a mobile health intervention through a digital application to reduce cardiovascular disease risk factors in young black women, and identify benefits and barriers to participation. Methods: Forty black women aged 25–45 years completed four sessions of cardiovascular disease risk reduction education and a six-month smartphone cardiovascular disease risk reduction monitoring and coaching intervention, targeting heart-healthy behavior modifications. At follow-up, women responded to a semi-qualitative online survey assessing the user-friendliness and perceived helpfulness of the intervention. Results: Of 40 women, 38 completed the follow-up survey. Sixty per cent of participants reported that the applications were easy or very easy to maintain, 90% reported that the application was easy or very easy to use. Over 60% observed that their family’s nutrition improved “a lot” or “a medium amount,” and many participants noted positive changes in their children’s diets. Only 8% of participants cited time or cost required to prepare healthy foods as barriers to implementing dietary changes. Conclusions: The m-Health intervention was feasible as a means of cardiovascular disease risk reduction for young black women. In addition, we found that targeting women provided indirect benefits for other family members, especially children. Most of the participants did not encounter systemic barriers to participation, suggesting that mobile health interventions can be effective tools to improve health behaviors in vulnerable populations.
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Affiliation(s)
| | - DK Moser
- College of Nursing, University of Kentucky, USA
| | - N Alshurafa
- Department of Computer Science, University of California-Los Angeles, USA
| | - K Watson
- Department of Cardiology, University of California-Los Angeles, USA
| | - JA Eastwood
- School of Nursing, University of California-Los Angeles, USA
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 550] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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New Approaches in Hypertension Management: a Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care. Curr Hypertens Rep 2019; 21:44. [PMID: 31025117 PMCID: PMC6483962 DOI: 10.1007/s11906-019-0949-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract Hypertension is a key risk factor for cardiovascular disease. Currently, around a third of people with hypertension are undiagnosed, and of those diagnosed, around half are not taking antihypertensive medications. The World Health Organisation (WHO) estimates that high blood pressure directly or indirectly causes deaths of at least nine million people globally every year. Purpose of Review In this review, we examine how emerging technologies might support improved detection and management of hypertension not only in the wider population but also within special population groups such as the elderly, pregnant women, and those with atrial fibrillation. Recent Findings There is an emerging trend to empower patients to support hypertension screening and diagnosis, and several studies have shown the benefit of tele-monitoring, particularly when coupled with co-intervention, in improving the management of hypertension. Summary Novel technology including smartphones and Bluetooth®-enabled tele-monitoring are evolving as key players in hypertension management and offer particular promise within pregnancy and developing countries. The most pressing need is for these new technologies to be properly assessed and clinically validated prior to widespread implementation in the general population.
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Brecthel L, Gainey J, Penwell A, Nathaniel TI. Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients. BMC Neurol 2018; 18:215. [PMID: 30577762 PMCID: PMC6302528 DOI: 10.1186/s12883-018-1204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients. METHODS Structured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model. RESULTS The non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025-1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16-3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961-0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032-0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223-0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046-0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322-12.611, P = 0.014). CONCLUSION The direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.
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Affiliation(s)
- Leanne Brecthel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Jordan Gainey
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Alexandria Penwell
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA.
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Razmak J, Bélanger CH, Farhan W. Development of a techno-humanist model for e-health adoption of innovative technology. Int J Med Inform 2018; 120:62-76. [PMID: 30409347 DOI: 10.1016/j.ijmedinf.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/04/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE After investing billions of dollars in an integrated Electronic Medical Records (physicians) and Personal Health Records (patients) system to allow both parties to manage and communicate through e-health innovative technologies, Canada is still making slow adoption progress. In an attempt to bridge the human and technological perspectives by developing and testing a holistic model, this study purports to predict patients' behavioral intentions to use e-health applications. METHODS An interdisciplinary approach labelled as a techno-humanism model (THM) is testing twelve constructs identified from the technological, sociological, psychological, and organizational research literature and deemed to have a significant effect upon and positive relationship with patients' e-health applications adoption. Subjects were Canadians recruited in a mall-intercept mode from a region representing a demographically diverse population, including rural and urban residents. The SmartPLS measurement tool was used to evaluate the reliability and validity of study constructs. The twelve constructs were separately tested with quantitative data such as factor analysis, single, multiple, and hierarchical multiple regression. RESULTS The hierarchical multiple regression analysis process led us to formulate four models, each hinged on a combination of interdisciplinary variables. Model 1 consisted of the technological predictors and explained 62.3% (p < .001) of variance in the behavioral intention to use e-health. Model 2 added the sociological predictors to the equation and explained 72.3% (p < .001) of variance. Model 3 added the psychological predictors to Model 2 and explained 72.8% (p < .001). Finally, Model 4 included all twelve predictors and explained 73% (p < .001) of variance in the behavioral intention to use e-health applications. CONCLUSIONS One of the greatest barriers to applying e-health records in Canada resides in the lack of coordination among stakeholders. The present study implies that healthcare policy makers must consider the twelve variables with their findings and implications as a whole. The techno-humanist model (THM) we are proposing is a more holistic and continuous approach. It pushes back to a breakdown of the various technological, sociological, psychological, and managerial factors and stakeholders that are at the root cause of behavioral intentions to use e-health, as opposed to merely observing behavioral outcomes at the end of the "assembly line". Active participation and coordination of all stakeholders is a key feature.
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Affiliation(s)
- Jamil Razmak
- College of Business, Al Ain University of Science and Technology, United Arab Emirates.
| | | | - Wejdan Farhan
- College of Business, Al Ain University of Science and Technology, United Arab Emirates.
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Walsh A, Travis S. What's app? Electronic health technology in inflammatory bowel disease. Intest Res 2018; 16:366-373. [PMID: 30090035 PMCID: PMC6077306 DOI: 10.5217/ir.2018.16.3.366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/30/2022] Open
Abstract
Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.
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Affiliation(s)
- Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
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Albrecht L, Wood PW, Fradette M, McAlister FA, Rabi D, Boulanger P, Padwal R. Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study. JMIR Aging 2018; 1:e10975. [PMID: 31518242 PMCID: PMC6716488 DOI: 10.2196/10975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. OBJECTIVE The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. METHODS We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. RESULTS Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. CONCLUSIONS Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.
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Affiliation(s)
- Lauren Albrecht
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Miriam Fradette
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Parati G, Dolan E, McManus RJ, Omboni S. Home blood pressure telemonitoring in the 21st century. J Clin Hypertens (Greenwich) 2018; 20:1128-1132. [DOI: 10.1111/jch.13305] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
| | - Eamon Dolan
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences; Green Templeton College; University of Oxford; Oxford UK
| | - Stefano Omboni
- Clinical Research Unit; Italian Institute of Telemedicine; Solbiate Arno Italy
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