Adherence to comprehensive interventions for management of uncontrolled hypertension Conference Paper uri icon
Overview
abstract
  • Home blood pressure (BP) monitoring has been advocated as a method for improving BP control, but there is little data on patients' long-term adherence. We describe adherence to home BP telemonitoring and telephone case management visits with a pharmacist. This analysis includes 160 patients with uncontrolled BP enrolled in a randomized clinical trial who had completed 24 weeks of intensive intervention. They were asked to measure their BP a minimum of 6 times per week using a telemonitor that transmitted the readings via a modem to the case manager. Adherence to telemonitoring was defined as measuring >6 BPs/week for at least 17 (70%) of the 24 weeks. Across the 160 participants, the percentage of weeks with at least 6 readings taken ranged from 4% - 100% (mean 80%, median 88%, 25th percentile: 71%, 75th percentile 96%). 83% of participants had measured >6 BPs/week for at least 17 (70%) of the 24 weeks. Adherence was significantly higher in whites (85%) vs non-whites (66%) (p=0.04) and in people age 65 (90%) vs <65 (77%) (p=0.03, mean age was 64). Employment status was also significantly related to adherence (p=0.05) with 77% adherence in those employed full time, 95% in those employed part time, 88% in retirees and 67% in the unemployed. Adherence did not vary significantly by gender (p=0.2) or education (p=0.14). In a multivariable analysis of these factors, older age was a significant independent predictor of adherence (OR 2.99, p=0.04). The mean number of BP readings taken increased from month 1 (49) to month 2 (73), and then gradually decreased month 3-6, but still remained at recommended levels (66, 58, 50, and 40). Adherence to 6 mandatory phone visits with study pharmacists was also high, at 90.1% (865/960 visits complete), similar to adherence to the 6 month research clinic visit at 94% (151/160 visits completed). Despite an intensive visit and measurement schedule, adherence to BP telemonitoring was very high in the study population, and was maintained over 6 months. We conclude that this comprehensive intervention has the potential to improve BP control by conveying reliable blood pressure data to healthcare providers who can then close the feedback loop by making appropriate therapeutic adjustments.

  • publication date
  • 2011
  • Research
    keywords
  • Cardiovascular Diseases
  • Drugs
  • Hypertension
  • Patient Compliance
  • Randomized Controlled Trials
  • Telemedicine