Abstract 10478: Reductions in Blood Pressure Persist One Year After Completing a Web-Based Team Care Intervention to Improve Hypertension Control
Introduction: The Electronic Communications and Home Blood Pressure Trial (e-BP) demonstrated that Web-based collaborative pharmacist care leads to decreased BP. The long-term effect of Web-based team interventions on BP is unknown. We report here BP outcomes one year after the end of the e-BP study.
Setting: e-BP was conducted at Group Health Cooperative, an integrated healthcare plan in Western Washington with an existing secure patient Web portal with a patient-shared EMR.
Methods: From 2006-7, 778 patients with uncontrolled BP were randomized to receive (1) Usual Care (UC), (2) a home BP monitor and training to use the existing Web portal, or (3) this, plus Web-based collaborative pharmacist care. Compared to UC, Web-pharmacy patients had improved BP control (RR 1.84, CI, 1.5 - 2.3) and greater reduction of systolic BP (difference in mean reduction: -8.9 mm Hg, 95% CI, -11.4, -6.3) and diastolic BP compared to UC (-3.5 mm Hg, P>.001) at the end of the 12-month intervention. We extracted BP data collected during primary care visits approximately 1 year after all active interventions ended.
Results: Of the 778 patients in the trial 93% (721/778) were still enrolled and 63% (493/778) had a BP recorded in the EMR 1 year after the study ended. For the Web-pharmacy patients, both the difference between adjusted mean change in systolic BP (-4.6 mm HG, 95% CI -8.1 to -1.1) and the proportion controlled (adjusted RR 1.22, 95% CI 1.00 to 1.48) were statistically significant compared to UC, and remained statistically significant using an intent to treat worst-case analysis carrying baseline BP forward. In those with more severe systolic hypertension (>160 mmHg) at baseline, difference in mean reduction in systolic BP in the Web pharmacist group compared to UC was -12.2 mmHg (-21.3, -3.2) 1 year after the study ended. Factors related to persistent BP control will be presented.
Conclusion: Reductions in systolic BP and improvements in BP control persisted, but were attenuated, 1 year after the end of the Web-based pharmacist intervention. Some patients with uncontrolled BP at baseline will continue to benefit from a Web-based pharmacist intervention, while others may need booster interventions or different types of interventions to maintain or achieve BP control.
- © 2011 by American Heart Association, Inc.