Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study.

Sulki Park,Hye-Chung Kum,Mark A Lawley,Qi Zheng,Michael A Morrisey

doi:10.2196/29018

Abstract

BackgroundAlmost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems.ObjectiveThe aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control.MethodsThis study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days.ResultsThe mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort.ConclusionsAlthough we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence.

Highlights

BackgroundHypertension affects nearly half of the adults in the United States, costs approximately US $131 billion annually, and is a major risk factor for cardiovascular disease and stroke [1,2,3]
The aims of this study are to (1) investigate how well Texas Medicaid patients adhere to daily blood pressure and pulse rate monitoring when supported by a daily telemonitoring services company, (2) determine whether an adherence reminder call intervention improves the daily transmission rate, and (3) investigate any association between daily adherence and blood pressure control
The data of 2093 clients enrolled in hypertension telemonitoring were provided

Summary

Introduction

BackgroundHypertension affects nearly half of the adults in the United States, costs approximately US $131 billion annually, and is a major risk factor for cardiovascular disease and stroke [1,2,3]. The 2010 and 2014 surveys of Canadian patients at a hypertension clinic where patients were encouraged to conduct home blood pressure monitoring found that only 39.2% and 40.6%, respectively, reported blood pressure more than 80% of the time [10]. Poor patient adherence to daily monitoring and reporting could significantly undermine the positive effects observed in clinical trials. Clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control.

Objectives

Methods

Results

Conclusion