Remote outpatient follow-up of patients with arterial hypertenson: the role of a nurse

Abstract

Highlights. Telehealth remote monitoring for patients with arterial hypertension has been developed and implemented. A nurse coaching approach has been reported.Aim. To develop and implement the technology of remote dispensary observation of patients with arterial hypertension (AH) using telemedicine, in which the main performer is a clinic nurse.Methods. The research object is patients with AH who are under dispensary observation at the territorial polyclinic. The study included 183 patients aged 53±12.5 years, of which 64.5% were women. The duration of observation is from 30 to 90 days. The effectiveness was evaluated on the basis of the achievement of target values of blood pressure (BP), number of visits to the doctor for hypertension decompensation, patient compliance. The program used data processing technology applying telemedicine devices for automatic BP measurement.Results. In 75.5% of cases, there was a decrease in the average level of systolic and diastolic BP in comparison with the initial levels. A decrease in the maximum systolic BP and in the frequency of decompensation episodes of BP above 160 mm Hg was recorded in 15.8% of patients. Achievement of the target BP level was identified in 64.2% of patients, in 11.3% there was a positive dynamic in the clinical condition without achieving the target figures, in 24.5% of cases, no dynamics was found. The majority of patients (84.2%) preferred remote forms of counseling while maintaining a stable level of indicators. Among 15.8% of patients, the number of visits to a doctor decreased from 2.0 to 0.75 visits per month. High adherence to preventive measures was observed in 88.7% of cases; 100% of patients in the observation group confirmed the use of prescribed antihypertensive drugs.Conclusion. The original technology of remote dispensary observation of patients with AH using telemedicine devices enhances the continuity in “doctor-nurse-patient” interactions, which contributes to the improvement of medical efficiency by increasing the proportion of patients in the dispensary group who have reached the target level of BP and increase the patients' adherence to preventive measures. Telemedicine technologies reduce the number of scheduled and urgent patient visits to a polyclinic, which is relevant in the context of the shortage of medical personnel and the transition to remote consultation due to the restrictions caused by the epidemic threat [17].