Abstract 16311: Impact of Telemedicine System on Blood Pressure Control in an Urban Medically Underserved Population
Background: Hypertension (HTN) affects more than 65 million people in the US with African Americans disproportionately affected. Telemedicine communication may improve blood pressure (BP) outcomes by empowering patients to take an active role through self-monitoring, education, reinforcement and feedback. These factors may impact the patient-provider interaction.
Methods: Urban medically underserved patients (N=211, African-Americans=165) with no overt CVD, with a Framingham 10-year CVD risk score >10% were randomized into usual care (UC) and usual care plus telemedicine (T) and followed for 1-year. T subjects reported blood pressure using an Internet-based system and received feedback on BP management. At 4 office visits, we assessed patient-physician interaction via a questionnaire. To examine the impact of telemedicine usage, we ranked the hypertensive T patients (SBP ≥ 140 mmHg, N=49) by number of data transmissions and compared the bottom quartile (L, N=13, ≤2 transmissions/year) to the highest quartile (H, N=13, > 28 transmissions/year).
Results: There were no differences in age [L 59.5 ±11.2, H 64.2 ± 9.5], BMI [L 33.0±3.4, H 30.8 ±7.6 kg/m2], systolic [L 152.2±11.1, H 150.5 ±8.4 mmHg] or diastolic BP [L 90.5±8.5, H 83.5 ±9.9 mmHg]. At 1-year, diastolic BP [L 82.3±9.9, H 73.2±8.9, p<0.05] decreased in both groups, but systolic BP [L 146.7 ±17.7, H 128.6±15.8, p<0.05] only decreased in the H-group. The decrease in systolic BP was significantly greater in the high quartile [change in SBP L -5.5±19.6, H -21.9±17.0]. Telemedicine impacted patient-physician interactions: the H-group reported that their physician was aware of them sending data [L 3 yes, H 13 yes, p <0.001] and that the physician asked questions on labs [L 0 yes, H 7 yes, p =0.009]. Patients in the H-group had their medication altered as a result of the data transmissions [L 1 yes, H 8 yes, p= 0.017].
Conclusion: Reduction in BP is greatest in subjects with the highest frequency of BP measurement using the Telemedicine system. The system worked best when the physician was aware of the patient's involvement and the physician had an active role. This reporting system allows patient to take a more active role in their own health care and encouraged more patient-physician interaction.
- © 2011 by American Heart Association, Inc.