PS-BPC11-7: SEX DIFFERENCES IN BLOOD PRESSURE CONTROL FOLLOWING REMOTE PATIENT MONITORING IMPLEMENTATION WITH AND WITHOUT CARE COORDINATION: A PROSPECTIVE COHORT STUDY

Abstract

Objective: Evaluate sex and race/ethnicity subgroup differences in the effects of care coordinator-assisted implementation of remote patient monitoring (RPM) and RPM implementation alone for hypertension in primary care compared to usual care. Design and Methods: Subgroup analysis of 3-arm pragmatic pilot cohort study. At two clinics, nurse care coordinators with physician approval, offered RPM to eligible patients and assisted with initiation. At two clinics, RPM was solely at physician discretion. Twenty clinics continued with usual care. Eligible patients were aged 65–85y with Medicare insurance and had uncontrolled hypertension (last two office BP > = 140/90 mm Hg). The primary outcome assessed at 6 months was controlling high blood pressure (< 140/90 mm Hg) at the most recent measurement. We tested for interactions between group and sex and between group and race ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic and others) in generalized linear models adjusted for age and baseline systolic BP. Results: In this cohort (234 RPM plus care coordination, 600 RPM only, 1617 usual care), we detected effect heterogeneity by sex (p = 0.02) but not race/ethnicity (p = 0.17). In sex-stratified analyses, the odds of controlling high blood pressure at 6 months in the RPM plus care coordination compared to control were 1.62 times higher (95% CI 1.09–2.41, P = 0.02) for women and 1.17 times higher (0.65–2.13, P = 0.6) for men. Corresponding odds comparing the RPM alone to control were 1.63 (1.24–2.13, P < 0.001) for women and 0.86 (0.55–1.34, P = 0.51) for men. RPM uptake in the care coordination group was 18% (27/153) for women and 14% (11/81) for men, compared with 0.7% (3/422) for women and 0% (0/178) for men in the RPM alone group. Among RPM-prescribed patients with baseline BP > = 140/90 mm Hg in the care coordination plus RPM group, usage following a RPM prescription was high (90% for women and 100% in men), antihypertensive medication intensification over the course of 6 months occurred for the plurality of patients (37% and 47%). SBP decline at 6 months was substantial (mean [SD] 23.6 [27.2] and 21.1 [21.2] mmHg). Conclusions: Introducing remote patient monitoring with and without care coordination appeared to have greater effects on BP control in women. Greater rates of RPM prescribing to women compared to men may account for these findings. Larger studies are needed to explore these differences.