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Bandeira ACN, Gama de Melo PU, Johann EB, Ritti-Dias RM, Rech CR, Gerage AM. Effect of m-Health-Based Interventions on Blood Pressure: An Updated Systematic Review with Meta-Analysis. Telemed J E Health 2024; 30:2402-2418. [PMID: 38946603 DOI: 10.1089/tmj.2023.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: In recent years, the integration of mobile health (m-Health) interventions has garnered increasing attention as a potential means to improve blood pressure (BP) management in adults. This updated systematic review with meta-analysis aimed to identify the effect of m-Health-based interventions on BP in adults and to evaluate the effect of m-Health on BP according to the characteristics of subjects, interventions, and countries. Methods: The search was carried out in PubMed, Embase, ResearchGate, and Cochrane databases in January 2022. Study selection and data extraction were performed by two independent reviewers. For analysis, random effects models were used with a confidence interval (CI) of 95% and p < 0.05. Results: Fifty studies were included in this review and in the meta-analysis. Interventions with m-Health reduced systolic BP in 3.5 mmHg (95% CI -4.3; -2.7; p < 0.001; I2 = 85.8%) and diastolic BP in 1.8 mmHg (95% CI -2.3; -1.4; p < 0.001; I2 = 78.9%) compared to usual care. The effects of m-Health interventions on BP were more evident in men and in older adults, in interventions lasting 6-8 weeks, with medication reminders, with the possibility of insertion of BP values (p < 0.05). Conclusion: The results of this study support the effectiveness of m-Health in reducing BP when compared to standard care. However, these effects are dependent on the characteristics of the subjects and interventions. Given the substantial heterogeneity among the results of this systematic review with meta-analysis, its interpretation should be cautious. Future research on this topic is warranted.
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Affiliation(s)
- Antonio Cleilson Nobre Bandeira
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Paulo Urubatan Gama de Melo
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eduardo Braghini Johann
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Cassiano Ricardo Rech
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Aline Mendes Gerage
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
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Sakima A, Akagi Y, Akasaki Y, Fujii T, Haze T, Kawakami-Mori F, Kitajima K, Kobayashi Y, Matayoshi T, Sakaguchi T, Yamazato M, Abe M, Ohya Y, Arima H. Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis. Hypertens Res 2024:10.1038/s41440-024-01792-7. [PMID: 38977877 DOI: 10.1038/s41440-024-01792-7] [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: 05/23/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024]
Abstract
This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.
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Affiliation(s)
- Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan.
| | - Yuya Akagi
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takako Fujii
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Kanagawa, Japan
| | - Fumiko Kawakami-Mori
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ken Kitajima
- Department of Cardiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Kobayashi
- Co-Creation Innovation Center, Yokohama City University, Kanagawa, Japan
| | | | - Takashi Sakaguchi
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ohya
- University Hospital of the Ryukyus, Okinawa, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Acharya M, Ali MM, Bogulski CA, Pandit AA, Mahashabde RV, Eswaran H, Hayes CJ. Association of Remote Patient Monitoring with Mortality and Healthcare Utilization in Hypertensive Patients: a Medicare Claims-Based Study. J Gen Intern Med 2024; 39:762-773. [PMID: 37973707 PMCID: PMC11043264 DOI: 10.1007/s11606-023-08511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Hypertension management is complex in older adults. Recent advances in remote patient monitoring (RPM) have warranted evaluation of RPM use and patient outcomes. OBJECTIVE To study associations of RPM use with mortality and healthcare utilization measures of hospitalizations, emergency department (ED) utilization, and outpatient visits. DESIGN A retrospective cohort study. PATIENTS Medicare beneficiaries aged ≥65 years with an outpatient hypertension diagnosis between July 2018 and September 2020. The first date of RPM use with a corresponding hypertension diagnosis was recorded (index date). RPM non-users were documented from those with an outpatient hypertension diagnosis; a random visit was selected as the index date. Six months prior continuous enrollment was required. MAIN MEASURES Outcomes studied within 180 days of index date included (i) all-cause mortality, (ii) any hospitalization, (iii) cardiovascular-related hospitalization, (iv) non-cardiovascular-related hospitalization, (v) any ED, (vi) cardiovascular-related ED, (vii) non-cardiovascular-related ED, (viii) any outpatient, (ix) cardiovascular-related outpatient, and (x) non-cardiovascular-related outpatient. Patient demographics and clinical variables were collected from baseline and index date. Propensity score matching (1:4) and Cox regression were performed. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. KEY RESULTS The matched sample had 16,339 and 63,333 users and non-users, respectively. Cumulative incidences of mortality outcome were 2.9% (RPM) and 4.3% (non-RPM), with a HR (95% CI) of 0.66 (0.60-0.74). RPM users had lower hazards of any [0.78 (0.75-0.82)], cardiovascular-related [0.79 (0.73-0.87)], and non-cardiovascular-related [0.79 (0.75-0.83)] hospitalizations. No significant association was observed between RPM use and the three ED measures. RPM users had higher hazards of any [1.10 (1.08-1.11)] and cardiovascular-related outpatient visits [2.17 (2.13-2.19)], while a slightly lower hazard of non-cardiovascular-related outpatient visits [0.94 (0.93-0.96)]. CONCLUSIONS RPM use was associated with substantial reductions in hazards of mortality and hospitalization outcomes with an increase in cardiovascular-related outpatient visits.
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Affiliation(s)
- Mahip Acharya
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ambrish A Pandit
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruchira V Mahashabde
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare Systems, North Little Rock, AR, USA.
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Yu H, Chen X, Xia J, Hou L. Effect of intelligent hypertension management system on blood pressure: protocol for a randomised controlled multicentre trial. BMJ Open 2023; 13:e074580. [PMID: 38086588 PMCID: PMC10729063 DOI: 10.1136/bmjopen-2023-074580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Hypertension is one of the most serious global health problems, and its prevention and treatment mainly rely on lifestyle intervention and medication. However, the current situation of hypertension control in China is still not ideal. Self-monitoring of blood pressure is expected to be a new way to control hypertension. Intervention and the Intelligent Hypertension Management System (IHMS), an information platform relying on the network and smartphone, may help patients self-monitor their blood pressure at home, allowing for intelligent management of hypertension. The aim of this trial is to investigate whether IHMS can effectively reduce blood pressure in patients with hypertension. METHODS AND ANALYSIS This is a multiple-centre, prospective, randomised, controlled study. 320 eligible subjects will be randomly divided into the IHMS management group (n=160) and the conventional care group (n=160). Subjects in the IHMS management group will be required to take their blood pressure daily at regular intervals at home and get treatment as directed by the IHMS; the control group will receive conventional treatment. The primary outcome of the trial is the net change in systolic blood pressure at the end point of follow-up after 3 months. The mixed-effects model will be used to compare the primary outcome that there is a greater reduction in blood pressure in the intervention group than in the control group. ETHICS AND DISSEMINATION The Ethics Committee of Shanghai Tongren Hospital has reviewed and approved the trial protocols, informed consent and subject information. The findings from the study will be disseminated through publications and conference presentations. The findings of the trial will be published in journals and presented at academic conferences. TRIAL REGISTRATION NUMBER NCT05526300.
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Affiliation(s)
- Haiyang Yu
- Department of cardiology, Shanghai Songjiang District Central Hospital, Songjiang, Shanghai, China
| | - Xiang Chen
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiachun Xia
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Hou
- Department of cardiology, Shanghai Songjiang District Central Hospital, Songjiang, Shanghai, China
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
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Franzoi MA, Gillanders E, Vaz-Luis I. Unlocking digitally enabled research in oncology: the time is now. ESMO Open 2023; 8:101633. [PMID: 37660408 PMCID: PMC10482746 DOI: 10.1016/j.esmoop.2023.101633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- M A Franzoi
- Cancer Survivorship Group, Inserm Unit 981, Gustave Roussy, Villejuif
| | - E Gillanders
- Cancer Survivorship Group, Inserm Unit 981, Gustave Roussy, Villejuif
| | - I Vaz-Luis
- Cancer Survivorship Group, Inserm Unit 981, Gustave Roussy, Villejuif; Department for the Organization of Patient Pathways, DIOPP, Gustave Roussy, Villejuif, France.
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Kim KK, McGrath SP, Solorza JL, Lindeman D. The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community. Appl Clin Inform 2023; 14:644-653. [PMID: 37201542 PMCID: PMC10431973 DOI: 10.1055/a-2096-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. OBJECTIVES The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. METHODS ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. RESULTS Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). CONCLUSION The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
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Affiliation(s)
- Katherine K. Kim
- MITRE Corporation, Health Innovation Center, McLean, Virginia, United States
- Department of Public Health Sciences, Division of Health Informatics, University of California Davis, School of Medicine, Sacramento, California, United States
| | - Scott P. McGrath
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
| | - Juan L. Solorza
- Livingston Community Health, Livingston, California, United States
| | - David Lindeman
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
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Petito LC, Anthony L, Peprah YA, Lee JY, Li J, Sato H, Persell SD. Remote physiologic monitoring for hypertension in primary care: a prospective pragmatic pilot study in electronic health records using propensity score matching. JAMIA Open 2023; 6:ooac111. [PMID: 36743315 PMCID: PMC9890085 DOI: 10.1093/jamiaopen/ooac111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives Since 2019, the Centers for Medicare and Medicaid Services covers remote physiologic monitoring (RPM) for blood pressure (BP) per hypertension diagnosis and treatment guidelines. Here, we integrated Omron VitalSight RPM into the health system's electronic health record to transmit BP and pulse without manual entry, assessed feasibility, and used pragmatic prospective matched cohort studies to assess initial effects in (1) uncontrolled (last two office BP ≥140/90 mmHg) and (2) general (diagnosed hypertension or last office BP ≥140/90 mmHg) hypertension patient populations. Materials and Methods Seventeen clinicians at two internal medicine practices were oriented. Eligible patients were aged 65-85 years had Medicare insurance with ≥1 office visit in the previous year. We prospectively identified matched controls (age, sex, BP, and number of office visits in previous year) from other primary care practices within the health system and estimated the association between RPM availability (clinic-level) and patient BP outcomes after 6 months. ClinicalTrials.gov: NCT04604925. Results Feasibility. Uptake was low at pilot clinics: 10 physicians prescribed RPM to 118 patients during the 6-month pilot. This included 7% (14/207) of the prespecified uncontrolled hypertension cohort and 3.3% (78/2356) of the general hypertension cohort. Surveyed clinicians (n = 4) reported changing their patients' medical treatment in response to RPM BPs, although they recommended having a dedicated RN or LPN to review BP readings. Effectiveness. At 6 months, BP control was greater at pilot practices than among matched controls (uncontrolled: 31.4% vs 22.8%; P = .007; general: 64.0% vs 59.7%; P < .001). Systolic BP at last office visit did not differ (mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P = .48) in the uncontrolled population, and was lower in the general population (131.8 [15.7] vs 132.8 [15.9]; P = .04).The frequency of antihypertensive medication changes was similar in both groups (uncontrolled P = .986; general P = .218). Discussion and Conclusions Uptake notwithstanding, RPM may have improved BP control. A potential mechanism is increased physician awareness of and attention to uncontrolled hypertension. Barriers to RPM use among physicians require further study.
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Affiliation(s)
- Lucia C Petito
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lauren Anthony
- Northwestern Medical Group Quality and Patient Safety, Northwestern Memorial Healthcare, Chicago, Illinois, USA
| | - Yaw Amofa Peprah
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ji Young Lee
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jim Li
- Clinical Development Department, Technology Development HQ, Omron Healthcare, Co., Ltd, Kyoto, Japan
| | - Hironori Sato
- Product Innovation Department, Technology Development HQ, Omron Healthcare, Co., Ltd, Kyoto, Japan
| | - Stephen D Persell
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Makutonin M, Dare J, Heekin M, Salancy A, Hood C, Dominguez LW. Remote Patient Monitoring for Hypertension: Feasibility and Outcomes of a Clinic-Based Pilot in a Minority Population. J Prim Care Community Health 2023; 14:21501319231204586. [PMID: 37815085 PMCID: PMC10563450 DOI: 10.1177/21501319231204586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population. METHODS In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs. RESULTS A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, P = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, P = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, P < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, P = .135). Financially, the program generated margins of $29 per patient at 90 days. CONCLUSIONS Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.
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Affiliation(s)
| | - Justin Dare
- Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Heekin
- The George Washington University, Washington, DC, USA
| | | | - Colton Hood
- The George Washington University, Washington, DC, USA
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Kaihara T, Intan-Goey V, Scherrenberg M, Falter M, Kario K, Akashi Y, Dendale P. Automatic transmission of home blood pressure data can be effective in managing hypertension: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:638-653. [PMID: 36710899 PMCID: PMC9779889 DOI: 10.1093/ehjdh/ztac049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/20/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
Aims Home blood pressure telemonitoring (HBPT) is a useful way to manage BP. Recent advances in digital technology to automatically transmit BP data without the patient input may change the approach to long-term BP treatment and follow-up. The purpose of this review is to summarize the latest data on the HBPT with automatic data transmission. Methods and results Articles in English from 1980 to 2021 were searched by electronic databases. Randomized controlled trials comparing HBPT with automatic data transmission with usual BP management and including systolic BP (SBP) and/or diastolic BP (DBP) as outcomes in hypertension patients were included in the systematic review. A meta-analysis was conducted. After removing duplicates, 474 papers were included and 23 papers were identified. The HBPT with automatic data transmission had a significant beneficial impact on BP reduction (mean difference for office SBP -6.0 mm Hg; P < 0.001). Subgroup analyses showed that the studies using smartphone applications reduced BP significantly more in the intervention group than in the control group (standardized mean difference for office and home SBP -0.25; P = 0.01) as did the studies using HBPT other than the applications. Longer observation periods showed a sustained effect, and multidisciplinary cooperation was effective. Conclusion This review suggests that a care path based on HBPT with automatic data transmission can be more effective than classical management of hypertension. In particular, the studies using smartphone applications have shown beneficial effects. The results support the deployment of digital cardiology in the field of hypertension management.
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Affiliation(s)
- Toshiki Kaihara
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, UHasselt, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, 216-8511 Kawasaki, Japan
| | - Valent Intan-Goey
- Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Martijn Scherrenberg
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, UHasselt, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Faculty of Medicine, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Maarten Falter
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, UHasselt, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Faculty of Medicine, KULeuven, Oude Markt 13, 3000 Leuven, Belgium
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, 329-0498 Shimotsuke, Japan
| | - Yoshihiro Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, 216-8511 Kawasaki, Japan
| | - Paul Dendale
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, UHasselt, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
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10
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Navathe AS, Crowley A, Liao JM. Remote Patient Monitoring-Will More Data Lead to More Health? JAMA Intern Med 2022; 182:1007-1008. [PMID: 35913717 DOI: 10.1001/jamainternmed.2022.3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amol S Navathe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Aidan Crowley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle.,Value & Systems Science Lab, Seattle, Washington
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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12
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Treadwell JR, Rouse B, Reston J, Fontanarosa J, Patel N, Mull NK. Consumer Devices for Patient-Generated Health Data Using Blood Pressure Monitors for Managing Hypertension: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33261. [PMID: 35499862 PMCID: PMC9112087 DOI: 10.2196/33261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes. Objective We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes. Methods An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results. Results We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non–BP monitor groups. Adherence to using consumer BP monitors ranged from 38% to 89%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts). Conclusions Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers.
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Affiliation(s)
| | | | | | | | - Neha Patel
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nikhil K Mull
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, United States
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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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14
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Park SH, Shin JH, Park J, Choi WS. An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010583. [PMID: 34682329 PMCID: PMC8535932 DOI: 10.3390/ijerph182010583] [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] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022]
Abstract
Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.
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Affiliation(s)
- Sang-Hyun Park
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Jong-Ho Shin
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Joowoong Park
- Research Strategy Division, Korea Aerospace Research Institute (KARI), Daejeon 34133, Korea;
| | - Woo-Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
- Keyu Internal Medicine Clinic, Daejeon 35250, Korea
- Correspondence: ; Tel.: +82-42-483-7554; Fax: +82-42-485-7554
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Cavero-Redondo I, Saz-Lara A, Sequí-Dominguez I, Gómez-Guijarro MD, Ruiz-Grao MC, Martinez-Vizcaino V, Álvarez-Bueno C. Comparative effect of eHealth interventions on hypertension management-related outcomes: A network meta-analysis. Int J Nurs Stud 2021; 124:104085. [PMID: 34601205 DOI: 10.1016/j.ijnurstu.2021.104085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increasingly, health professionals and patients have begun to be involved in eHealth interventions to assist in the self-management of hypertension. Therefore, this study was aimed at comparing the effect of different types of eHealth interventions (phone calls, blood pressure telemonitoring, emails, web-site, smartphone-app, short message service (SMS) and more than two eHealth interventions) on reducing systolic and diastolic blood pressure, increasing adherence to medication treatment, improving physical activity compliance, controlling blood pressure, and improving quality of life (QoL). METHODS A systematic search in MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to identify experimental studies addressing the effect of eHealth interventions on the self-management of hypertension. Comparative evaluation of the eHealth interventions effect were performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between eHealth interventions and control/non-intervention. RESULTS Fifty-one studies were included in the analysis showing a moderate effect size for more than two types of eHealth interventions (-0.46; 95%CI: -0.64, -0.27, p < 0.001 and -0.29; 95%CI: -0.46, -0.13, p < 0.001), phone calls (-0.37; 95%CI: -0.57, -0.17, p < 0.001 and -0.29; 95%CI: -0.52, -0.07, p = 0.011) and smartphone-app (-0.26; 95%CI: -0.50, -0.01, p = 0.040 and -0.40; 95%CI: -0.70, -0.10, p = 0.010) on reducing both systolic and diastolic blood pressure, respectively. Additionally, i) smartphone-app improved medication adherence by 45%; ii) more than two types of eHealth interventions and emails improved physical activity compliance by 18% and 57% respectively; ii) more than two types of eHealth interventions, phone calls, blood pressure telemonitoring, website and SMS improved blood pressure control between 16% and 30%; and iv) blood pressure telemonitoring showed a week effect on QoL CONCLUSIONS: Our study reported eHealth to be a suitable intervention for the self-management of hypertension. Considering our results and the population's accessibility to eHealth devices, eHealth could be a useful and largely scalable tool for the self-management of hypertension. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020187468.
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Affiliation(s)
- Iván Cavero-Redondo
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
| | - Alicia Saz-Lara
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | - Irene Sequí-Dominguez
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | | | - Vicente Martinez-Vizcaino
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Celia Álvarez-Bueno
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
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Clarke J, Flott K, Fernandez Crespo R, Ashrafian H, Fontana G, Benger J, Darzi A, Elkin S. Assessing the safety of home oximetry for COVID-19: a multisite retrospective observational study. BMJ Open 2021; 11:e049235. [PMID: 34521666 PMCID: PMC8441226 DOI: 10.1136/bmjopen-2021-049235] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To determine the safety and effectiveness of home oximetry monitoring pathways for patients with COVID-19 in the English National Health Service. DESIGN Retrospective, multisite, observational study of home oximetry monitoring for patients with suspected or proven COVID-19. SETTING This study analysed patient data from four COVID-19 home oximetry pilot sites in England across primary and secondary care settings. PARTICIPANTS A total of 1338 participants were enrolled in a home oximetry programme across four pilot sites. Participants were excluded if primary care data and oxygen saturations at rest at enrolment were not available. Data from 908 participants were included in the analysis. INTERVENTIONS Home oximetry monitoring was provided to participants with a known or suspected diagnosis of COVID-19. Participants were enrolled following attendance to emergency departments, hospital admission or referral through primary care services. RESULTS Of 908 patients enrolled into four different COVID-19 home oximetry programmes in England, 771 (84.9%) had oxygen saturations at rest of 95% or more, and 320 (35.2%) were under 65 years of age and without comorbidities. 52 (5.7%) presented to hospital and 28 (3.1%) died following enrolment, of which 14 (50%) had COVID-19 as a named cause of death. All-cause mortality was significantly higher in patients enrolled after admission to hospital (OR 8.70 (2.53-29.89)), compared with those enrolled in primary care. Patients enrolled after hospital discharge (OR 0.31 (0.15-0.68)) or emergency department presentation (OR 0.42 (0.20-0.89)) were significantly less likely to present to hospital than those enrolled in primary care. CONCLUSIONS This study finds that home oximetry monitoring can be a safe pathway for patients with COVID-19; and indicates increases in risk to vulnerable groups and patients with oxygen saturations <95% at enrolment, and in those enrolled on discharge from hospital. Findings from this evaluation have contributed to the national implementation of home oximetry across England.
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Affiliation(s)
- Jonathan Clarke
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
| | - Kelsey Flott
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Gianluca Fontana
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Elkin
- National Heart and Lung Institute, Imperial College London, London, UK
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17
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Park S, Kum HC, Morrisey MA, Zheng Q, Lawley MA. Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study. J Med Internet Res 2021; 23:e29018. [PMID: 34486977 PMCID: PMC8453343 DOI: 10.2196/29018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence.
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Affiliation(s)
- Sulki Park
- Population Informatics Lab, Texas A&M University, College Station, TX, United States.,Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station, TX, United States.,Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Department of Health Policy and Management, Texas A&M University, College Station, TX, United States
| | - Michael A Morrisey
- Department of Health Policy and Management, Texas A&M University, College Station, TX, United States
| | - Qi Zheng
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, United States
| | - Mark A Lawley
- Population Informatics Lab, Texas A&M University, College Station, TX, United States.,Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, United States
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de TelessaúdeHospital das Clínicasand Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queensand School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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19
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. Ann Noninvasive Electrocardiol 2021; 26:e12795. [PMID: 33513268 PMCID: PMC7935104 DOI: 10.1111/anec.12795] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queens, and School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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20
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:7-48. [PMID: 36711170 PMCID: PMC9708018 DOI: 10.1093/ehjdh/ztab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health, Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu Y, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:4-54. [PMID: 35265889 PMCID: PMC8890358 DOI: 10.1016/j.cvdhj.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Key Words
- ACC, American College of Cardiology
- ACS, acute coronary syndrome
- AED, automated external defibrillator
- AF, atrial fibrillation
- AHA, American Heart Association
- AHRE, atrial high-rate episode
- AI, artificial intelligence
- APHRS, Asia Pacific Heart Rhythm Society
- BP, blood pressure
- CIED, cardiovascular implantable electronic device
- CPR, cardiopulmonary resuscitation
- EHR A, European Heart Rhythm Association
- EMR, electronic medical record
- ESUS, embolic stroke of unknown source
- FDA (U.S.), Food and Drug Administration
- GPS, global positioning system
- HCP, healthcare professional
- HF, heart failure
- HR, heart rate
- HRS, Heart Rhythm Society
- ICD, implantable cardioverter-defibrillator
- ILR, implantable loop recorder
- ISHNE, International Society for Holter and Noninvasive Electrocardiology
- JITAI, just-in-time adaptive intervention
- MCT, mobile cardiac telemetry
- OAC, oral anticoagulant
- PAC, premature atrial complex
- PPG, photoplethysmography
- PVC, premature ventricular complexes
- SCA, sudden cardiac arrest
- TADA, Technology Assissted Dietary Assessment
- VT, ventricular tachycardia
- arrhythmias
- atrial fibrillation
- comorbidities
- digital medicine
- heart rhythm
- mHealth
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health Policy and Research, Weill Cornell Medicine, New York, NY, USA
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22
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol 2021; 14:e009204. [PMID: 33573393 PMCID: PMC7892205 DOI: 10.1161/circep.120.009204] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | | | | | | | - Yu-Feng Hu
- Taipei Veterans General Hospital, Taiwan (Y.-F.H.)
| | | | | | | | | | | | | | - Reena Mehra
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | - Alex Page
- University of Rochester, NY (J.-P.C., A.P., J.S.S.)
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL (R. Passman)
| | | | - Ewa Piotrowicz
- National Institute of Cardiology, Warsaw, Poland (E.P., R. Piotrowicz)
| | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | | | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - David Slotwiner
- Cardiology Division, New York-Presbyterian Queens, NY (D.S.)
| | | | - Emma Svennberg
- Karolinska University Hospital, Stockholm, Sweden (E.S.)
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23
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Yatabe J, Yatabe MS, Ichihara A. The current state and future of internet technology-based hypertension management in Japan. Hypertens Res 2020; 44:276-285. [PMID: 33361825 PMCID: PMC7756130 DOI: 10.1038/s41440-020-00591-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
Internet-based information and communication technology is altering our lives. Although medicine is traditionally conservative, it can benefit in many ways from adopting new technology and styles of care. Hypertension is a prime condition for the practical application of digital health management because it is prevalent and undercontrolled, and its primary index, home blood pressure, can be effectively telemonitored. Compared to other conditions that require laboratory measures or the use of drugs with frequent side effects, hypertension can be managed without actual office visits with sufficiently low risk. In this review of hypertension in Japan, we discuss the current and somewhat fragmented state of internet technology and the components and processes necessary for smooth, integrated, and multidisciplinary care in the future. Although further clinical trials are required to show the safety and efficacy of information and communication technology-based care for hypertension, the deployment of telemonitoring and telemedicine in daily practice should be expedited to solve the hypertension paradox. Challenges remain relating to cost, data integration, the redesigning of team-based care, and the improvement of user experience, but information and communication technology-based hypertension management is sure to become pivotal in improving public health.
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Affiliation(s)
- Junichi Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.
| | - Midori Sasaki Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.,Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
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24
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Mao Y, Lin W, Wen J, Chen G. Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001225. [PMID: 32988849 PMCID: PMC7523197 DOI: 10.1136/bmjdrc-2020-001225] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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25
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Camhi SS, Herweck A, Perone H. Telehealth Training Is Essential to Care for Underserved Populations: a Medical Student Perspective. MEDICAL SCIENCE EDUCATOR 2020; 30:1287-1290. [PMID: 32837786 PMCID: PMC7299135 DOI: 10.1007/s40670-020-01008-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Telehealth is an area of medicine which has magnified the ability to treat patients remotely. Presently the education of medical professionals pertaining to the value, use, and implementation of telehealth is not adequate to harness the potential of available technologies. Patients engaging in telehealth experience time and cost savings, improved disease management through remote monitoring programs, and high-quality care regardless of geographic location. Despite this, medical education has been slow to evolve. It is therefore imperative that medical curricula incorporate training for this rapidly advancing mode of healthcare delivery to enable students to best care for their future patient population.
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Affiliation(s)
- Stephanie S. Camhi
- MD/MPH Program, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA
| | - Alexandra Herweck
- MD/MPH Program, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA
| | - Hanna Perone
- MD/MPH Program, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA
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26
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Kim BJ, Park JM, Park TH, Kim J, Lee J, Lee KJ, Lee J, Chae JE, Thabane L, Lee J, Bae HJ. Remote blood pressure monitoring and behavioral intensification for stroke: A randomized controlled feasibility trial. PLoS One 2020; 15:e0229483. [PMID: 32160205 PMCID: PMC7065804 DOI: 10.1371/journal.pone.0229483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
Measuring blood pressure (BP) at home and remote monitoring can improve the patient’s adherence to BP control and vascular outcomes. This study evaluated the feasibility of a trial regarding the effects of an intensive mobile BP management strategy versus usual care in acute ischemic stroke patients. A feasibility-testing, randomized, open-labeled controlled trial was conducted. Remote BP measurement, data transmission, storage, and centralized monitoring system were organized through a Bluetooth-equipped sphygmomanometer paired to the participants’ smartphones. Participants were randomized equally into intensive management (behavioral intensification to measure BP at home by texting, direct telephone call, or breakthrough visit) and control (usual care) groups. The primary feasibility outcomes were: 1) recruitment time for the pre-specified number of participants, 2) retention of participants, 3) frequency of breakthrough visit calls, 4) response to breakthrough visit call, and 5) proportions satisfying BP measurement criteria. Sixty participants were randomly assigned to the intensive management (n = 31) and control (n = 29) groups, of which 57 participants were included in the primary analysis with comparable baseline characteristics. Recruitment time from the first to the last participant was 350 days, and 95% of randomized participants completed the final visit (intensive, 94%; control, 98%). Eight breakthrough visit calls were made to 7 participants (23%), with complete and immediate responses within 3 ± 4 days. The median of half-day blocks fulfilling the BP measurement criteria per patient were 91% in the intensive group and 83% in the control group (difference, 12.2; 95% confidence interval, 2.2–22.2). No adverse events related to the trial procedures were reported. The intensive monitoring, including remote BP measurement, data transfer, and centralized monitoring system, engaged with behavioral intensification was feasible if the patients complied with the intervention. However, the device utilized would need further improvement prior to a large trial.
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Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Moo Park
- Nowon Eulji Medical Center, Department of Neurology, Eulji University, Seoul, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Joungsim Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - JongShill Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - JiSung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Eun Chae
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph’s Healthcare—Hamilton, Hamilton, Ontario, Canada
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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27
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Zhu H, Zheng H, Liu X, Mai W, Huang Y. Clinical applications for out-of-office blood pressure monitoring. Ther Adv Chronic Dis 2020; 11:2040622320901660. [PMID: 32010437 PMCID: PMC6974752 DOI: 10.1177/2040622320901660] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022] Open
Abstract
Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician's office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.
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Affiliation(s)
- Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Weiyi Mai
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road 1, Lunjiao Town, Shunde District, Foshan, Guangdong 523808, China
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28
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Choi WS, Shin IS, Yang JS. Understanding Moderators of Home Blood Pressure Telemonitoring Systems in Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. Telemed J E Health 2019; 26:1016-1034. [PMID: 31855113 DOI: 10.1089/tmj.2019.0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Factors affecting the effectiveness of telemonitoring in home blood pressure telemonitoring (HBPT) must be examined in an integrated analysis in urban hypertensive patients. Materials and Methods: In a systematic review of electronic databases, we retrieved 1,433 citations and selected 34 comparisons. Specified moderators were the duration of the intervention, the frequency of remote transmission of blood pressure (BP) data, the additional intervention, and the intervention pathway. Results: For the duration of follow-up of HBPT, the weighted mean difference (WMD) in systolic blood pressure (SBP) between two groups was 11.900 mmHg (p-value <0.001) at 2 months and 3.024 mmHg (p = 0.002) at 12 months. The WMD in SBP was 5.512 mmHg (p < 0.001) in cases where data were transmitted daily and 1.818 mmHg (p = 0.084) for monthly transmission. For the group in which further interventions with HBPT were conducted, the WMD in SBP was 3.813 mmHg (p < 0.001). For patients who did not receive additional interventions, the WMD was 2.747 mmHg (p = 0.005). For the pathway of HBPT, the WMD was 6.800 mmHg (p = 0.053) when BP values were remote transmitted through letter, 3.041 mmHg (p = 0.001) through mobile phone/web, 2.224 mmHg (p = 0.043) through telephone-linked computer system, and 4.352 mmHg (p < 0.001) through telephone. Conclusions: The effects of moderators of HBPT systems utilized with urban hypertensive patients differ from those in interventions that did not distinguish urban from rural areas. Results for duration of implementation and frequency of data transmission were significant. Among the interventions using telecommunications, the telephone was the most effective in comparison to other channels.
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Affiliation(s)
- Woo Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Keyu Internal Medicine Clinic, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Transdisciplinary Security, Dongguk University, Seoul, Republic of Korea
| | - Jae-Suk Yang
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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29
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Choi WS, Choi JH, Oh J, Shin IS, Yang JS. Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. Telemed J E Health 2019; 26:744-759. [PMID: 31532328 DOI: 10.1089/tmj.2019.0028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Remote home blood pressure monitoring (RBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of RBPM for urban hypertensive patients. Methods: We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of RBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control. Results: We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for RBPM for systolic BP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212, 95% confidence interval 0.148-0.275; p < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, p < 0.001) and the effect of RBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; p = 0.018). Conclusions: This review demonstrates that RBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of RBPM in preventing hypertensive cardiovascular complications.
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Affiliation(s)
- Woo Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Keyu Internal Medicine Clinic, Daejeon, Republic of Korea
| | - Jin Hyuk Choi
- Department of Philosophy, University of Warwick, Coventry, United Kingdom
| | - Jiwon Oh
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Education, Jeonju University, Jeonju, Republic of Korea
| | - Jae-Suk Yang
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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30
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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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31
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Palacholla RS, Fischer N, Coleman A, Agboola S, Kirley K, Felsted J, Katz C, Lloyd S, Jethwani K. Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review. JMIR Cardio 2019; 3:e11951. [PMID: 31758771 PMCID: PMC6834226 DOI: 10.2196/11951] [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: 08/20/2018] [Revised: 12/13/2018] [Accepted: 01/16/2019] [Indexed: 01/14/2023] Open
Abstract
Background The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. Objective This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. Methods This review followed the methodological framework developed by Arskey and O’Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. Results A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. Conclusions Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness.
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Affiliation(s)
- Ramya Sita Palacholla
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Nils Fischer
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Amanda Coleman
- American Medical Association, Chicago, IL, United States
| | - Stephen Agboola
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | | | - Jennifer Felsted
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Chelsea Katz
- American Medical Association, Chicago, IL, United States
| | - Stacy Lloyd
- American Medical Association, Chicago, IL, United States
| | - Kamal Jethwani
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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Davis TC, Hoover KW, Keller S, Replogle WH. Mississippi Diabetes Telehealth Network: A Collaborative Approach to Chronic Care Management. Telemed J E Health 2019; 26:184-189. [PMID: 30822265 DOI: 10.1089/tmj.2018.0334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background/Introduction: Ineffective management of chronic illness and lack of referral sources in underserved areas has contributed to increased health care spending and a decline in quality of life for the affected. In 2016, 15.4% of the adult population of Mississippi had diabetes. Telehealth in the home is a viable way to bring a care team to patients to assist them as they manage their illnesses. The purpose of the study was to determine the relationship between the Mississippi Diabetes Telehealth Network clinical care model and selected diabetes outcomes over time. Methods: A prospective, longitudinal cohort study design evaluated the relationship between using telehealth for chronic care management and diabetes outcomes over a 12-month period. Eligible participants were patients over 18 years old diagnosed with diabetes at a rural health clinic with an hemoglobin A1c (HbA1c) ≥7.0%. Rolling enrollment continued until the pool of eligible participants was depleted. A total of 171 were enrolled. Results: There was a significant difference in HbA1c values from baseline to 3-, 6-, 9-, and 12-month values. A significant difference was found between baseline and 12-month measures for total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL), triglycerides, creatinine clearance, glomerular filtration rate, and potassium. There were no differences in baseline and 12-month measures for weight, blood pressure, blood urea nitrogen (BUN), and microalbumin. Discussion/Conclusions: Even with the limited sample size and design, remote patient monitoring and telehealth may be an effective tool for assisting home-based patients in the self-management of diabetes in rural areas. The maximum benefit was achieved after 3-4 months on the program and maintained over the 12-month period.
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Affiliation(s)
| | - Kim W Hoover
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sheila Keller
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
| | - William H Replogle
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
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Shoulders B, Powell L. Reaching for Goal: Incorporating the Latest Hypertension Guidelines Into Practice. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Noah B, Keller MS, Mosadeghi S, Stein L, Johl S, Delshad S, Tashjian VC, Lew D, Kwan JT, Jusufagic A, Spiegel BMR. Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ Digit Med 2018; 1:20172. [PMID: 31304346 PMCID: PMC6550143 DOI: 10.1038/s41746-017-0002-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022] Open
Abstract
Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (-0.73; 95% CI: -1.84, 0.38), weight (-1.29; -3.06, 0.48), waist circumference (-2.41; -5.16, 0.34), body fat percentage (0.11; -1.56, 1.34), systolic blood pressure (-2.62; -5.31, 0.06), and diastolic blood pressure (-0.99; -2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.
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Affiliation(s)
- Benjamin Noah
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Michelle S Keller
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Sasan Mosadeghi
- 4Department of Medicine, University of Arizona, College of Medicine Tucson, Tucson, AZ USA
| | - Libby Stein
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sunny Johl
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sean Delshad
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Vartan C Tashjian
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Lew
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - James T Kwan
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Alma Jusufagic
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Brennan M R Spiegel
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA.,American Journal of Gastroenterology, Bethesda, USA
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Yatabe MS, Yatabe J, Asayama K, Staessen JA, Mujaj B, Thijs L, Ito K, Sonoo T, Morimoto S, Ichihara A. The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study. Blood Press 2017; 27:99-105. [PMID: 29172715 DOI: 10.1080/08037051.2017.1406306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Although self-measurement of home blood pressure (HBP) is common in Japan and HBP telemonitoring via the Internet is possible, whether telemonitoring improves HBP control better than conventional practice remains unclear. Furthermore, hypertension care with online communication using telemonitored HBP is feasible, whereas the efficacy and safety of such telemedicine have not been established. We aim to compare traditional care, care with office visits using HBP telemonitoring, and antihypertensive telemedicine based on HBP telemonitoring. METHODS AND DESIGN In total, 444 patients with uncontrolled hypertension will be recruited and randomly assigned to three groups: (1) control: usual care with office visits and HBP self-report, (2) telemonitoring: weekly assessment of transmitted HBP by physicians and treatment adjustment upon office visits, or (3) telemedicine: online communication instead of office visits to adjust medication using telemonitored HBP. Primary outcome is the time to control of HBP, and secondary outcomes include achieved HBP levels, adherence, treatment intensity, adverse events, patient satisfaction and cost-effectiveness. DISCUSSION Hypertension care with telemonitoring and telemedicine are expected to require shorter time to achieve HBP control compared to usual care. Combining HBP telemonitoring with telemedicine may lower the hurdles for starting and persisting to hypertension treatment and eventually reduce cardiovascular events.
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Affiliation(s)
- Midori Sasaki Yatabe
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Junichi Yatabe
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan.,b Tohoku Institute for Management of Blood Pressure , Sendai , Japan
| | - Kei Asayama
- b Tohoku Institute for Management of Blood Pressure , Sendai , Japan.,c Department of Hygiene and Public Health , Teikyo University School of Medicine , Tokyo , Japan
| | - Jan A Staessen
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Blerim Mujaj
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Lutgarde Thijs
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Kyotaro Ito
- e Division of Medical Research , PORT incorporation , Tokyo , Japan
| | - Tomohiro Sonoo
- e Division of Medical Research , PORT incorporation , Tokyo , Japan
| | - Satoshi Morimoto
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Atsuhiro Ichihara
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
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Chia YC, Buranakitjaroen P, Chen CH, Divinagracia R, Hoshide S, Park S, Shin J, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Turana Y, Wang JG, Wong L, Zhang Y, Kario K. Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2017; 19:1192-1201. [PMID: 28815840 DOI: 10.1111/jch.13058] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
Abstract
Hypertension represents a major burden in Asia, with a high prevalence rate but poor level of awareness and control reported in many countries in the region. Home blood pressure monitoring has been validated as an accurate and reliable measure of blood pressure that can help guide hypertension treatment as well as identify masked and white-coat hypertension. Despite its benefits, there has been limited research into home blood pressure monitoring in Asia. The authors reviewed the current evidence on home blood pressure monitoring in Asia, including but not limited to published literature, data presented at congresses, and national hypertension management guidelines to determine the current utilization of home blood pressure monitoring in clinical practice in the region. Public policies to enable greater access to home blood pressure monitoring and its use in clinical care would add considerably to improving hypertension outcomes in Asia.
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Affiliation(s)
- Yook-Chin Chia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Sunway lnstitute for Healthcare Development, Sunway University, Selangor Darul Ehsan, Malaysia
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chen-Huan Chen
- Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea
| | - Jinho Shin
- Faculty of Cardiology Service, Hanyang University Medical Center, Seongdong, Seoul, Korea
| | | | - Jorge Sison
- Department of Medicine, Medical Center Manila, Ermita, Manila, Philippines
| | - Arieska Ann Soenarta
- Department Cardiology and Vascular Medicine, Faculty of Medicine, Harapan Kita, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- Apollo Hospitals, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yuda Turana
- Department of Neurology, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta, Indonesia
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lawrence Wong
- Department of Medicine & Therapeutics, Division of Neurology, Chinese University of Hong Kong, Hong Kong
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Duan Y, Xie Z, Dong F, Wu Z, Lin Z, Sun N, Xu J. Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies. J Hum Hypertens 2017; 31:427-437. [PMID: 28332506 DOI: 10.1038/jhh.2016.99] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/11/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022]
Abstract
To summarise evidence about the effectiveness of home blood pressure telemonitoring (HBPT) and identify the key components of intervention. We comprehensively searched PubMed, EMBASE and the Cochrane Library for relevant studies. The authors were contacted for additional information. Two authors independently extracted the data and assessed the risk of bias. 46 randomised controlled trials including a total of 13 875 cases were identified. Compared with usual care, HBPT improved office systolic blood pressure (BP) and diastolic BP by 3.99 mm Hg (95% confidence interval (CI): 5.06-2.93; P<0.001) and 1.99 mm Hg (95% CI: -2.60 to -1.39; P<0.001), respectively. A larger proportion of patients achieved BP normalisation in the intervention group (relative risk (RR): 1.16; 95% CI: 1.08-1.25; P<0.001). For HBPT plus additional support (including counselling, education, behavioural management, medication management with decision, adherence contracts and so on) versus HBPT alone (or plus less intense additional support), the mean changes in systolic and diastolic BP were 2.44 mm Hg (95% Cl, 4.88 to 0.00 mm Hg; P=0.05) and 1.12 mm Hg (95% CI, -2.34 to 0.1 mm Hg; P=0.07), respectively. For those surrogate outcomes, low-strength evidence failed to show difference. In subgroup analysis, high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel. HBPT can improve BP control in the hypertensive patients. It may be more efficacious when a proactive additional support is provided during the intervention process.
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Affiliation(s)
- Y Duan
- First Clinical Medical College, Southern Medical University, Guangzhou, China
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Xie
- First Clinical Medical College, Southern Medical University, Guangzhou, China
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - F Dong
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Wu
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Lin
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - N Sun
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
- Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - J Xu
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
- Clinical Medical College, Guangdong Pharmaceutical University, Guangzhou, China
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Lee CJ, Park S. The Role of Home Blood Pressure Telemonitoring for Blood Pressure Control. Pulse (Basel) 2016; 4:78-84. [PMID: 27752479 DOI: 10.1159/000448375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/13/2016] [Indexed: 01/13/2023] Open
Abstract
Despite improvements in hypertension awareness and treatment, the blood pressure (BP) control rate still remains at around 50%. One of the major determinants of low BP control results from therapeutic inertia of the physician and suboptimal compliance of the patients. Home BP self-measurement and monitoring improves patients' awareness and helps the management of hypertension. Recent technological advances are allowing for accurate measurement and telemonitoring of home BP, with a number of randomized clinical trials demonstrating the efficacy of telemonitoring for BP control. Home BP telemonitoring combined with self-adjustment based on prespecified treatment algorithms has been shown to improve BP control. Additionally, telemonitoring with active intervention by medical professionals has been shown to improve drug compliance and increase the target BP achievement rate. Although nothing can replace the tried and tested doctor-patient relationship in the office, telemonitoring of home BP will be an important tool for treating hypertension in the future.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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