Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis

• Published in: Applied clinical informatics 2014, Vol.5 (1), p.232-248
• Main Authors: Ralston, J D, Cook, A J, Anderson, M L, Catz, S L, Fishman, P A, Carlson, J, Johnson, R, Green, B B
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - therapeutic use; Blood Pressure Monitoring, Ambulatory; Female; Follow-Up Studies; Humans; Hypertension - drug therapy; Male; Middle Aged; Negotiating; Randomized Controlled Trials as Topic; Telemedicine - methods
• ISSN: 1869-0327; 1869-0327
• DOI: 10.4338/ACI-2013-10-RA-0079

We evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension. We performed a mediation analysis of a published randomized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007. Study arms analyzed included usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care. Mediator measures included secure messaging and telephone encounters; home blood pressure monitoring; medications intensification and adherence and lifestyle factors. Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care (PACIC) instrument. The primary outcome was percent of participants with blood pressure (BP)