At-Home Blood Pressure Monitoring
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Fund for Public Health in New York
Southwest Brooklyn, Bronx, Harlem
Hypertension
Primary care health networks
African Americans, Latinos |
PROJECT
Patients transmit blood pressure readings using at-home monitors.
Patients discuss their blood pressure goal, monitoring regimen and action plan with their doctor and receive a blood pressure monitor for use at home. Patients are asked to transmit their readings once a month for nine months, and receive monthly reminders to transmit their data. The blood pressure monitors transmit the readings via modem and phone line to a secure database. The blood pressure readings are also recorded by patients on a tracking card and brought to follow-up
visits with their provider. This allows physicians to get a more complete picture of their patient’s health and potentially influence treatment decisions. The intervention is being implemented in three clinic networks.
RATIONALE
Self-monitoring of blood pressure has shown to be an effective tool for improving hypertension control. This project addresses both patient-and provider-level mechanisms that may lead to reductions in blood pressure and improved hypertension control.
Self-monitoring by patients may allow physicians to titrate medications more accurately, and it may encourage patients to more actively participate in their own health care. Home blood pressure readings have the potential to prompt physicians to advance care by monitoring blood pressure more frequently and therefore having more information to make clinical decisions. This may help overcome ‘clinical inertia,’ in which doctors fail to intensify treatment for patients who need it. At-home blood pressure monitoring may make an asymptomatic condition feel more “real” for patients, stimulating healthy behavior changes.
EVALUATION PLAN
Funded by Finding Answers in 2009.
Patients are participating in a randomized control trial to determine the effectiveness of the intervention versus treatment as usual. Researchers are examining blood pressure, blood pressure control, trajectory of blood pressure readings over time, and the frequency and patterns of blood pressure-monitor use. Some of the intervention participants are being randomly selected to participate in a focus group to share feedback about their experience using at-home blood pressure monitors. A clinic process evaluation is being undertaken to explore the practicality of incorporating self -monitoring of blood pressure into regular treatment for hypertension. This evaluation is examining various practical matters affecting the intervention,
including the clinic’s staff resources, time allocation and the efficacy of clinic tools and support provided.
Principal Investigators:
- Thomas Farley, MD, MPH (Commissioner, New York City Department of Health and Mental Hygiene)
- Sonia Y. Angell, MD, MPH, DTMH (Director of Cardiovascular Disease Prevention, New York City Department of Health and Mental Hygiene)
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