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Kuwajima S, Itoh T, Sato T, Ino S, Shibata S, Ohno K, Hotta H, Matsumoto T, Ooiwa H, Kubo H, Miki T. Influence of the COVID-19 pandemic on the achievement of guideline targets for HbA1c, blood pressure, and LDL cholesterol in people with diabetes in Japan. Diabetol Int 2024; 15:507-517. [PMID: 39101168 PMCID: PMC11291788 DOI: 10.1007/s13340-024-00715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/18/2024] [Indexed: 08/06/2024]
Abstract
Objective In this study, we investigated whether the COVID-19 pandemic affected achievement of guideline targets for HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol in people with diabetes mellitus (DM). Materials and methods Data for 556 people with DM who were treated regularly for 4 years before and during the COVID-19 pandemic in Japan were analyzed in this retrospective study. Achieved targets were defined as HbA1c < 7.0%, BP < 130/80 mmHg, and LDL cholesterol < 100 or < 120 mg/dL depending on the presence or absence of coronary artery disease. Results In 2019, before the start of the COVID-19 pandemic, achievement rates of guideline targets for HbA1c, BP and LDL cholesterol were 53.4%, 45.9% and 75.7%, respectively. In 2020, the achievement rates for HbA1c and BP targets were significantly decreased to 40.8% and 31.3%, respectively. The achievement rates for the HbA1c target gradually recovered to 49.3% in 2021 and to 51.1% in 2022. However, recovery in achieving the BP target was slow, remaining at 40.5% even in 2022. On the other hand, the achievement rate for the LDL cholesterol target was not affected and remained relatively high during the COVID-19 pandemic. Conclusions The rates of achieving therapeutic targets for HbA1c and BP have not been high enough in people with DM, and the rates were further reduced by lifestyle changes due to the COVID-19 pandemic. Although there has been a trend toward improvement with the lifting of behavioral restrictions, more intensified treatment is necessary to achieve good control. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-024-00715-8.
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Affiliation(s)
- Shingo Kuwajima
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Takahito Itoh
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Tatsuya Sato
- Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shoya Ino
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Satoru Shibata
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Kouhei Ohno
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Hiroyuki Hotta
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Tomoaki Matsumoto
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
- Medical Record Administration Center, Oji General Hospital, Tomakomai, Japan
| | - Hitoshi Ooiwa
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
| | - Hirofumi Kubo
- Medical Record Administration Center, Oji General Hospital, Tomakomai, Japan
| | - Takayuki Miki
- Department of Cardiology and Diabetes, Oji General Hospital, 3-4-8, Wakakusa-Cho, Tomakomai, 053-8506 Japan
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Li J, Tian A, Liu J, Ge J, Peng Y, Su X, Li J. Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China. CARDIOLOGY DISCOVERY 2024; 4:15-22. [PMID: 38505635 PMCID: PMC10947596 DOI: 10.1097/cd9.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
Objective Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence. Methods This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment. Results A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004). Conclusions HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.
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Affiliation(s)
- Jiaying Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jinzhuo Ge
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Xiaoming Su
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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Lee DR, Chenoweth M, Chuong LH, Villaflores CW, Cuevas M, Vangala S, Borenstein J, Kwak H, Chima-Melton C, Han M, Skootsky SA, Chan Tack T, Branagan L, Martin H, Gupta R, Phan L, Sanchez MA, Malaak MM, Dermenchyan A, Pearson KN, Altunyan M, Barakat PF, Pablo R, Sarkisian C. A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial. JMIR Res Protoc 2023; 12:e45915. [PMID: 37902819 PMCID: PMC10644190 DOI: 10.2196/45915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Hypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor. OBJECTIVE In this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement. METHODS We will conduct a randomized, comparative effectiveness trial at 3 large academic health centers across California. The 3 sites will enroll a total of 660 participants (approximately n=220 per site), with 330 in the integrated BP monitor arm and 330 in the nonintegrated BP control arm. The primary outcome of this study will be the absolute difference in systolic BP in mm Hg from enrollment to 6 months. Secondary outcome measures include binary measures of hypertension (controlled vs uncontrolled), hypertension-related health complications, hospitalizations, and death. The list of possible participants will be generated from a central data warehouse. Randomization will occur after enrollment in the study. Participants will use their assigned BP monitor and join site-specific hypertension interventions. Cross-site learning will occur at regular all-site meetings facilitated by the University of California, Los Angeles Value-Based Care Research Consortium. A pre- and poststudy questionnaire will be conducted to further evaluate participants' perspectives regarding their BP monitor. Linear mixed effects models will be used to compare the primary outcome measure between study arms. Mixed effects logistic regression models will be used to compare secondary outcome measures between study arms. RESULTS The study will start enrolling participants in the second quarter of 2023 and will be completed by the first half of 2024. Results will be published by the end of 2024. CONCLUSIONS This pragmatic trial will contribute to the growing field of chronic care management using remote monitoring by answering whether a hypertension intervention coupled with an electronic health record integrated home BP monitor improves patients' hypertension better than a hypertension intervention with a nonintegrated BP monitor. The outcomes of this study may help health system decision makers determine whether to invest in integrated BP monitors for vulnerable patient populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05390502; clinicaltrials.gov/study/NCT05390502. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45915.
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Affiliation(s)
- David R Lee
- Division of Geriatrics, University of California, Los Angeles, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew Chenoweth
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Linh H Chuong
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chad W Villaflores
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Miguel Cuevas
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sitaram Vangala
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeff Borenstein
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hannah Kwak
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chidinma Chima-Melton
- Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maria Han
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samuel A Skootsky
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- University of California Health, Oakland, CA, United States
| | - Therese Chan Tack
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Linda Branagan
- Telehealth Resource Center, University of California, San Francisco, San Francisco, CA, United States
| | - Heather Martin
- Department of Pharmacy, University of California Davis Health, Davis, CA, United States
| | - Reshma Gupta
- Department of Internal Medicine, University of California, Davis Health, Sacramento, CA, United States
| | - Linda Phan
- Department of Pharmacy, University of California Davis Health, Davis, CA, United States
| | - Michael A Sanchez
- University of California Office of the President, Oakland, CA, United States
| | - Mina M Malaak
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anna Dermenchyan
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kandyce N Pearson
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marine Altunyan
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Peter F Barakat
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ray Pablo
- University of California Health Data Warehouse, University of California Health, Irvine, CA, United States
| | - Catherine Sarkisian
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Geriatrics Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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Gunasekaran D, Turner JM. Current and Developing Technologies for BP Monitoring. Curr Cardiol Rep 2023; 25:1151-1156. [PMID: 37698819 DOI: 10.1007/s11886-023-01956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW To discuss new and emerging technologies for blood pressure measurement and monitoring, including the limitations of current blood pressure measurement techniques, hopes for new device technologies, and the current barriers impeding change in this space. RECENT FINDINGS A number of new cuffless devices are being developed and poised to emerge on the marketplace in coming years. There are several different types of technologies and sensors currently under study. New guidelines for validation of cuffless blood pressure devices have recently been developed in anticipation of this change. The current standards for blood pressure device validation are specific to cuff-based technology and are insufficient for validating devices with cuffless-based technologies. In anticipation of a number of new cuffless technologies coming to market in the coming years, three sets of standards have been developed and published in recent years to address this gap.
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Affiliation(s)
| | - Jeffrey M Turner
- Section of Nephrology, Yale School of Medicine, New Haven, CT, USA.
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Randomized Controlled Trial of Home Telemonitoring of Blood Pressure with an Adapted Tensiometer with SMS Capability. Eur J Investig Health Psychol Educ 2023; 13:440-449. [PMID: 36826217 PMCID: PMC9954846 DOI: 10.3390/ejihpe13020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Despite being a public health problem, less than a third of hypertensive patients manage to control blood pressure (BP). In this paper, we conducted a two-arm randomized controlled trial to investigate the efficacy of an SMS-based home BP telemonitoring system compared to usual care in patients with uncontrolled hypertension from a primary care center. This study was conducted between April and August 2018. Participants in the intervention arm used a custom-designed telemonitoring device for two weeks and were followed up for two additional weeks; controls were followed for 4 weeks. The main objective of this study is to evaluate the impact on blood pressure of a telemonitoring system using a blood pressure monitor adapted to send data via SMS to health providers in primary care centers for 4 weeks. In this trial, 38 patients were included in the analysis (18 in each arm), 68% were women, and the mean age was 68.1 [SD: 10.8 years], with no differences between arms. Among the results we found was that There was no significant difference in the change in systolic BP values between the control and intervention arm (-7.2 [14.9] mmHg vs. -16.3 [16.7] mmHg; p = 0.09). However, we found a significant difference in the change of diastolic BP (-1.2 [6.4] mmHg vs. -7.2 [9.8] mmHg; for the control and intervention arms, respectively p = 0.03). With all this, we conclude that an SMS-based home BP telemonitoring system is effective in reducing diastolic BP by working in conjunction with primary care centers. Our findings represent one of the first interventions of this type in our environment, being an important alternative for the control of high blood pressure.
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Kushniruk A, Teo SH, Tang WE, Ng DWL, Koh GCH, Teo VHY. Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views. JMIR Hum Factors 2023; 10:e36072. [PMID: 36602847 PMCID: PMC9853336 DOI: 10.2196/36072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. OBJECTIVE To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. METHODS A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. RESULTS In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). CONCLUSIONS Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care.
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Affiliation(s)
| | - Sok Huang Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Gerald Choon Huat Koh
- Ministry of Health Office for Healthcare Transformation, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Eze CE, Dorsch MP, Coe AB, Lester CA, Buis LR, Farris KB. Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study. Digit Health 2023; 9:20552076231187585. [PMID: 37529536 PMCID: PMC10387707 DOI: 10.1177/20552076231187585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Background Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring. Objective The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF). Methods This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis. Results Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance. Conclusion Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.
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Affiliation(s)
- Chinwe E Eze
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Corey A Lester
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen B Farris
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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Kunanon S, Roubsanthisuk W, Chattranukulchai P, Sangwatanaroj S, Ophascharoensuk V, Sitthisook S, Sukonthasarn A. 2022 Thai Hypertension Society guidelines on home blood pressure monitoring. J Clin Hypertens (Greenwich) 2022; 24:1139-1146. [PMID: 36196468 PMCID: PMC9532919 DOI: 10.1111/jch.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Abstract
In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125-134/75-84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is, < 125/75 mmHg for patients aged 18-65 years old, and <135/85 mmHg for patients over 65 years of age.
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Affiliation(s)
- Sirisawat Kunanon
- Division of HypertensionDepartment of MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Weranuj Roubsanthisuk
- Division of HypertensionDepartment of MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Pairoj Chattranukulchai
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Somkiat Sangwatanaroj
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Vuddhidej Ophascharoensuk
- Division of NephrologyDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Surapun Sitthisook
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
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Asayama K. Delicate but significant changes in blood pressure-the importance of clinical research by frontline clinicians. Hypertens Res 2022; 45:744-746. [PMID: 35145251 PMCID: PMC8830979 DOI: 10.1038/s41440-022-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. .,Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. .,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.
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