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Zhang Y, Chandra S, Peña MT, Lal L, Summers RL, Swint JM. Framework for Evaluating and Developing Sustainable Telehealth Programs. Telemed J E Health 2023; 29:1421-1425. [PMID: 36716266 DOI: 10.1089/tmj.2022.0407] [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: 02/01/2023] Open
Abstract
During the COVID-19 pandemic and public health emergency, telehealth programs vastly expanded with strong support from various federal and state agencies. However, the uncertainty regarding future reimbursement policies for telehealth services has resulted in concerns about long-term sustainability of innovative health service delivery models beyond the financial support. Given the limited literature on creating telehealth programs with long-term sustainability in consideration, we have developed a framework for gathering appropriate data during various stages of program implementation to evaluate clinical effectiveness and economic sustainability that is applicable across various settings, with additional attention to health equity. Recognizing the difficulty of sustaining telehealth programs solely through a fee-for-service payment model, we encourage all telehealth stakeholders, especially payers and policymakers, to consider cost-effectiveness of telehealth programs and support alternate payment models for ensuring long-term sustainability.
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Affiliation(s)
- Yunxi Zhang
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Saurabh Chandra
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Center for Telehealth, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maria T Peña
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas, USA
| | - Lincy Lal
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas, USA
| | - Richard L Summers
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John Michael Swint
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas, USA
- Center for Clinical Research and Evidence-Based Medicine, John P and Katherine G McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Weaver DJ, Waldo A, Oh GJ, Kamil ES, Elliott M, Adler S, Pesenson A, Modes MM, Gipson P, Lafayette RA, Selewski DT, Attalla SE, Eikstadt R, Troost JP, Gipson DS, Massengill SF. Time to Initiation of Antihypertensive Therapy After Onset of Elevated Blood Pressure in Patients With Primary Proteinuric Kidney Disease. Kidney Med 2020; 2:131-138. [PMID: 32734234 PMCID: PMC7380443 DOI: 10.1016/j.xkme.2019.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective The objective of the study was to estimate the prevalence of hypertension in patients with proteinuric kidney disease and evaluate blood pressure (BP) control. Study Design Retrospective cohort study. Setting & Participants Data from adults and children with proteinuric kidney disease enrolled in the multicenter Kidney Research Network Registry were used for this study. Exposure Proteinuric kidney disease. Outcomes Hypertension and BP control. Analytical Approach Patients with white-coat hypertension were excluded. Patients were censored at end-stage kidney disease onset. Patients were defined as hypertensive either by hypertension diagnosis code, having 2 or more encounters with elevated BPs, or treatment with antihypertensive therapy excluding renin-angiotensin-aldosterone system blockade. Elevated BP was defined as greater than 95th percentile for children and >140/90 mm Hg in adults. Sustained BP control was defined as 2 or more consecutive encounters with BPs lower than 95th percentile for children and <140/90 mm Hg for adults. Kaplan-Meier and Cox proportional hazards analyses were used to evaluate the time to initiation of antihypertensive therapy. Results 842 patients, 69% adults and 31% children, with a total observation period of 6,722 patient-years were included in the analysis. 644 (76%) had hypertension during observation. There was no difference in the prevalence of hypertension between children and adults (74% vs 78%; P = 0.3). Hypertension was most common among those of African American race compared with other races (90% vs 72%-75%; P = 0.003). 504 (78%) patients with hypertension achieved BP control but only 51% achieved control within 1 year. 140 (22%) patients with hypertension never achieved BP control during a median of 41 (IQR, 24-73) months of observation. Limitations Differing BP control goals that may lead to overestimation of the controlled patient population. Conclusions Hypertension affects most patients with proteinuric kidney disease regardless of age. Time to BP control exceeded 1 year in 50% of patients with hypertension and 22% did not demonstrate control. This study highlights the need to address hypertension early and completely in disease management of patients with proteinuric kidney disease.
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Affiliation(s)
- Donald J Weaver
- Division of Pediatric Nephrology, Levine Children's Hospital at Atrium Health, Charlotte, NC
| | - Anne Waldo
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Gia J Oh
- Division of Nephrology, Department of Pediatrics, Stanford University, Stanford, CA
| | | | | | - Sharon Adler
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA
| | | | | | - Patrick Gipson
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.,Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - David T Selewski
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Samara E Attalla
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Richard Eikstadt
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Jonathan P Troost
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Susan F Massengill
- Division of Pediatric Nephrology, Levine Children's Hospital at Atrium Health, Charlotte, NC
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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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Johnson HM, Thorpe CT, Bartels CM, Schumacher JR, Palta M, Pandhi N, Sheehy AM, Smith MA. Antihypertensive medication initiation among young adults with regular primary care use. J Gen Intern Med 2014; 29:723-31. [PMID: 24493322 PMCID: PMC4000352 DOI: 10.1007/s11606-014-2790-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 12/03/2013] [Accepted: 01/10/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Young adults with hypertension have the lowest prevalence of controlled blood pressure compared to middle-aged and older adults. Uncontrolled hypertension, even among young adults, increases future cardiovascular event risk. However, antihypertensive medication initiation is poorly understood among young adults and may be an important intervention point for this group. OBJECTIVE The purpose of this study was to compare rates and predictors of antihypertensive medication initiation between young adults and middle-aged and older adults with incident hypertension and regular primary care contact. DESIGN A retrospective analysis PARTICIPANTS Adults ≥ 18 years old (n = 10,022) with incident hypertension and no prior antihypertensive prescription, who received primary care at a large, Midwestern, academic practice from 2008-2011. MAIN MEASURES The primary outcome was time from date of meeting hypertension criteria to antihypertensive medication initiation, or blood pressure normalization without medication. Kaplan-Meier analysis was used to estimate the probability of antihypertensive medication initiation over time. Cox proportional-hazard models (HR; 95% CI) were fit to identify predictors of delays in medication initiation, with a subsequent subpopulation analysis for young adults (18-39 years old). KEY RESULTS After a mean follow-up of 20 (±13) months, 34% of 18-39 year-olds with hypertension met the endpoint, compared to 44% of 40-59 year-olds and 56% of ≥ 60 year-olds. Adjusting for patient and provider factors, 18-39 year-olds had a 44% slower rate of medication initiation (HR 0.56; 0.47-0.67) than ≥ 60 year-olds. Among young adults, males, patients with mild hypertension, and White patients had a slower rate of medication initiation. Young adults with Medicaid and more clinic visits had faster rates. CONCLUSIONS Even with regular primary care contact and continued elevated blood pressure, young adults had slower rates of antihypertensive medication initiation than middle-aged and older adults. Interventions are needed to address multifactorial barriers contributing to poor hypertension control among young adults.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA,
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