Learning Session 2: Linking Patient Data from Home/Community to Clinical practice and How to Sustain Work Around Home Blood Pressure Monitoring

Speaker: Hayden Bosworth, PhD, Research Professor in the Department of Medicine, Division of General Internal Medicine, Research Professor in the Department of Psychiatry and Behavioral Sciences, Research Professor in the School of Nursing at Duke University Medical Center

Date: July 3 at 9am ET, 8am CT   

Listen to the presentation here. (19 minutes)

Resources:

Objectives of the presentation:

  • Define the role of visiting nurses and home health care agencies in improving blood pressure control.
  • Describe pilots or models for how home care can improve blood pressure.
  • Define reimbursement criteria for home health agencies.

Main points to be covered:

  • Home health and mobile health blood pressure monitoring can be practical approaches, using nurses in managing HBP through the telemedicine. 
  • Reimbursement issues for home blood pressure monitoring.
  • Successful state models in home blood pressure monitoring. 

Main points presented:

  • Definition of home blood pressure (BP) monitoring – Self monitoring blood pressure (SMBP) is defined as the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. 
  • Discussion of how it is operationalized and evidence for home BP monitoring - Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of ≥12 readings are recommended for making clinical decisions; demonstrated in previous study, minimum of three values over 2 weeks.
  • Review of the business case for home BP monitoring - HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.
  • Role of home BP monitoring and disparities -On a population level, home BP is lower than clinic BP.
  • Examples of prior programs using home BP monitoring – Take Control of Your Blood Pressure (TCYB) a 5-year randomized controlled trial with two patient self-management interventions designed to improve BP control and Hypertension Intervention Telemedicine Study (HINTS)  - an 18-month randomized controlled trial with 593 veterans enrolled, 49% being African Americans, and focused on patient self-management. 

Main take-away points:

  • There is evidence that home BP monitoring is beneficial – Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage.
  • Home BP monitoring may be beneficial particularly for some groups who may lack adequate access to health care - Benefits seen in the elderly, persons with diabetes, pregnant women, persons with kidney disease.
  • The cost of home BP monitoring appear to be low - Home BP monitoring combined with nurse case management resulted in observed net savings in outpatient care and overall medical care.
  • There is evidence of long term benefits, especially in African-American patients - The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans.