Implementing a Remote Blood Pressure Monitoring Program at Rural Resident Primary Care Clinic

Abstract

INTRODUCTION: We evaluated feasibility of implementing remote blood pressure (BP) monitoring (RBPM) program in rural resident primary care clinic. METHODS: This is Internal Medicine resident physicians-led single arm RBPM study among Medicare populations with hypertension in rural United States. Resident physicians provided a comprehensive self-management support (SS) and home BP guided pharmacotherapy over 6 months in collaboration with a third-party vendor. Our primary outcomes were changes between the first and the last 2 weeks of BP and its control (<130/80). Secondary outcomes were trend in home BP monitoring (HBPM), medication changes, progression towards patients' set SS goals and emergency room (ER) visits/hospitalization. RESULTS: Seventy-two patients provided 6 months of HBPM; 75% were White patients, 61.1% female and 81.9% from rural areas. They provided a mean (SD) of 7.3 (0.5) HBPM readings/week/patient that was stable over the study period. Mean (SD) BP difference and BP control were 11.4 (11.7)/3.4 (6.5) mmHg and 37.5% (all P < 0.01), respectively. One hundred and fifty-nine SS goals were set (66% either achieved or had progress made), 63.9% had medications changes. Twenty-four patients had ER visits; 16 were hospitalized, among them 4 ER visits were likely related to hypertension or anti-hypertensive medications which improved with medication changes. There were significant reductions in body mass index, cholesterol levels and glycated hemoglobin at the end of the study. CONCLUSIONS: Resident-led RBPM program is feasible and associated with significant BP reduction. Future studies should consider program evaluation to inform context-driven implementation.