Background Information: PICOT Question
What is the impact of utilizing telemonitoring blood pressure (BP) (I) in African Americans with hypertension (P) relative to conventional treatment (C) on BP control? (O). In the United States, approximately 45% of adults have high blood pressure, and only around 54% can control it (CDC, 2021). Hypertension is considered a death sentence due to symptoms’ absence. As such, those who have it tend to be unaware of their vulnerable condition (Lee & Park, 2016). It is therefore critical to monitor one’s blood pressure frequently to confirm that hypertension is not present. Home blood pressure telemonitoring paired with self-adjustment according to pre-set treatment algorithms can improve blood pressure control.
Current Research Findings
Many investigations have demonstrated that adding telemonitoring to BP control boosts its efficiency, resulting in more successful BP management. An example is a cohort study of 432 patients, which evaluated data from a telemedicine care center repository on hypertensive patients. Adults (40 years of age) with prehypertension or hypertension who lived independently or in rural areas of large cities were considered. Population information was gathered from 12 district government hospitals in Taipei, Taiwan (Lu et al., 2019). Data collected was systolic blood pressure and blood pressure irrespective of present BP control or treatment status. The patients were instructed to check their BP three times a week, with two measurements every morning before taking any antihypertensive medications. Two practice measurements were taken to ensure consistency in reading (Lu et al., 2019). According to the findings, patients getting care and treatment via home telemedicine experienced considerable increases in blood pressure control and a significant reduction in blood pressure than those receiving routine care.
Nevertheless, this study had significant drawbacks. First, there may have been a lack of consistency in collecting data since patients were required to collect and submit data independently. Thus, this process could have been affected by factors such as forgetfulness or patients going on vacation. Secondly, the study findings cannot be generalized because it was solely based in Taiwan.
A comparable study evaluated BP measures taken in the experimental hospital for those taken in the usual clinical treatment to see how long the treatment impact on BP lasted after several months of follow-up. Follow-up in this investigation was performed on a randomized cluster trial in 16 healthcare facilities and 450 unmanaged hypertensive patients in a large care facility for nine months (Margolis et al., 2018). Home blood pressure remote monitoring treatment with pharmacist supervision or conventional therapy were the interventions under focus. Pharmacists interacted with participants for a one-hour admission appointment, throughout which they administered an individualized treatment assessment, demonstrated how to operate the mobile BP telemonitoring equipment, and offered hypertension control advice (Margolis et al., 2018). Participants were provided a customized home BP target and asked to send not less than 6 BP measures weekly, divided into morning and evening measurements.
According to their findings, in 78 weeks, home BP remote monitoring treatment with pharmacist supervision reduced BP more than routine care, although this was not maintained for the next four years (Margolis et al., 2018). These findings are slightly different from those in the previous research in that outcomes were monitored for a continuous period. Given that this was a follow-up study, a potential limitation is that some patients might have stopped attending follow-up visits, which might have affected data collection.
Finally, a related analysis was carried out by Hammersley et al. (2020) to assess the efficiency and effectiveness of adopting a comprehensive telehealth supervision system for hypertension in regular primary care. The researchers invited 126 Lothian practices through a weekly bulletin. Practices that expressed a desire to participate received informational appointments and training. According to the researchers, NHS Lothian created a comprehensive system that offered routine overviews of client home-monitored BP measurements to their GP, which were transmitted together with regular lab tests, based on their past study with healthcare professionals on the good qualities of a telemonitoring system.
As a result, the experts examined the system’s deployment. They interviewed physicians and patients concerning their views about advances to identify what functioned and what did not regarding increasing acceptance. In total, the researchers recruited 118 telemonitoring patients with no less than one appointment registered prior to and after the treatment (Hammersley et al., 2020). The researchers gathered regularly gathered data on blood pressure, physician visits, and overall service utilization in a sample of eight practices and matched it to the preceding year (Hammersley et al., 2020). The utilization of resources was matched to clients with high blood pressure in the practices who were not provided telemonitoring treatment. The findings revealed that treatment was common in several practices, although not always. In contrast to the past year, clients who utilized the mechanism had far fewer visits throughout the treatment.
The study used regular data sources, which could be used to conduct future follow-up studies. On the other hand, patients texted in their blood pressure measurements, which might cause bias. Additionally, the number of patients with verified service consumption data from telemonitoring was fairly minimal, which means that the study cannot be generalized to all BP patient populations.
Proposal
The studies above reveal that home telemonitoring of BP can decrease BP for all population sizes participating in the experiments. The BP levels of patients who utilized telemonitoring and patients who did not exhibit substantial variations in both studies. Based on the findings from the studies above, this paper proposes the promotion of home-based telemonitoring of BP among African Americans with hypertension management. It is likely that with increased adoption, this patient population will better manage blood pressure. In general, the paper also proposes for home-based devices for hypertension control to be adequately integrated and identified for use by practitioners among disadvantaged populations.
References
Centers for Disease Control and Prevention. (2021). Facts about hypertension. Centers for Disease Control and Prevention.
Hammersley, V., Parker, R., Paterson, M., Hanley, J., Pinnock, H., Padfield, P.,… & McKinstry, B. (2020). Telemonitoring at scale for hypertension in primary care: An implementation study. PLoS medicine, 17(6), e1003124.
Lee, C. J., & Park, S. (2016). The role of home blood pressure telemonitoring for blood pressure control. Pulse, 4(2-3), 78-84.
Lu, J. F., Chen, C. M., & Hsu, C. Y. (2019). Effect of home telehealth care on blood pressure control: A public healthcare centre model. Journal of telemedicine and telecare, 25(1), 35-45.
Margolis, K. L., Asche, S. E., Dehmer, S. P., Bergdall, A. R., Green, B. B., Sperl-Hillen, J. M., Nyboer, R.A., Pawloski, P.A., Maciosek, M.V., Trower, N.K., & O’Connor, P. J. (2018). Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension: follow-up of a cluster randomized clinical trial. JAMA network open, 1(5), e181617-e181617.