Development of an entirely remote, non‐physician led hypertension management program

Background Hypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximi...

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Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2019-02, Vol.42 (2), p.285-291
Main Authors: Fisher, Naomi D.L., Fera, Liliana E., Dunning, Jacqueline R., Desai, Sonali, Matta, Lina, Liquori, Victoria, Pagliaro, Jaclyn, Pabo, Erika, Merriam, Mary, MacRae, Calum A., Scirica, Benjamin M.
Format: Article
Language:English
Subjects:
algorithm
Blood Pressure - physiology
Blood Pressure Monitoring, Ambulatory - methods
Clinical Investigations
Delivery of Health Care - organization & administration
Disease Management
Female
home blood pressure
Humans
Hypertension
Hypertension - physiopathology
Male
Middle Aged
patient navigation
Patients
Pilot Projects
Program Development - methods
Prospective Studies
remote
Telemedicine - methods
United States
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Summary:Background Hypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximize efficiency of care delivery and optimize control. Hypothesis We aimed to develop a remote, navigator‐led hypertension innovation program that would leverage algorithmic care pathways, home BP measurements and patient coaching to allow rapid and complete medication titration. Methods A multidisciplinary group of clinical experts from subspecialties and primary care collaborated to develop an evidence‐based clinical algorithm, designed to be automated and administered by non‐licensed patient navigators. In the development stage, a prospective pilot cohort of 130 patients was managed by nurse practitioners and pharmacists to ensure efficacy and safety. Patients with clinic BP ≥ 140/90 mm Hg were enrolled and given a Bluetooth‐enabled BP device. Home BPs were transmitted automatically into the electronic medical record. Medication titrations were performed by phone at biweekly intervals, based upon weekly average BP, until home BP was controlled at
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.23141