Abstract 12360: A Pilot Study of Remote Patient Monitoring for Hypertension in Primary Care

Abstract

Introduction: Out-of-office BP should guide hypertension care. CMS now covers remote patient monitoring (RPM). We assessed uptake and initial effects of introducing RPM. Hypothesis: At 6-months, hypertensive Medicare patients in RPM clinics would have greater antihypertensive medication intensification, better blood pressure control (NQF 0018), and lower SBP at last office visit. Methods: This was a pragmatic observational study in primary care in a single health system. We integrated Omron VitalSight TM RPM into the system’s EHR to enable transmission of BP and pulse from a BP monitor into the EHR without manual entry. We oriented two clinics [17 primary care physicians (PCPs)] using meetings and written material, leaving the decision to order RPM to PCPs. We compared their patients to controls from other clinics matched by age, sex, BP, and number of office visits in the prior year. We examined outcomes in: (P1) those with poor BP control at baseline—last two office BP ≥140/90, and (P2) all hypertensive patients (diagnosed hypertension or last office BP ≥140/90). Additional criteria included: age 65-85 years; ≥1 office visit in past year; and absence of persistent atrial fibrillation, CKD stage IV or V, or dementia. Results: RPM implementation was feasible. In P1, 207 intervention patients had mean (SD) baseline BP 151.7 (10.1) / 79.7 (8.1) mmHg, and 828 controls had BP 151.4 (10.6) / 79.5 (8.9) mmHg. In P2, 2356 intervention patients and 4712 controls had corresponding mean baseline BPs of 131.3 (14.7) / 74.9 (8.3) and 131.3 (14.7) / 74.8 (8.8) mmHg. During 6 months, PCPs ordered RPM for 14 (6.8%) P1 patients and 78 (3.3%) P2 patients. In both P1 and P2, NQF 0018 satisfaction was higher at RPM-eligible clinics (p = 0.044, 0.020 respectively) (Table). Medication intensification did not differ in P1 or P2. Conclusions: RPM uptake was modest. Controlling High Blood Pressure at 6 months favored the RPM intervention and was likely due to factors other than medication intensification.