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Meador M, Sachdev N, Anderson E, Roy D, Bay RC, Becker LH, Lewis JH. Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians. J Healthc Qual 2024; 46:109-118. [PMID: 38150376 PMCID: PMC10901219 DOI: 10.1097/jhq.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.
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Hayek MA, Giannouchos T, Lawley M, Kum HC. Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension: A Systematic Review. JAMA Netw Open 2023; 6:e2344372. [PMID: 37988078 PMCID: PMC10663963 DOI: 10.1001/jamanetworkopen.2023.44372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Blood pressure monitoring is critical to the timely diagnosis and treatment of hypertension. At-home self-monitoring techniques are highly effective in managing high blood pressure; however, evidence regarding the cost-effectiveness of at-home self-monitoring compared with traditional monitoring in clinical settings remains unclear. Objective To identify and synthesize published research examining the cost-effectiveness of at-home blood pressure self-monitoring relative to monitoring in a clinical setting among patients with hypertension. Evidence Review A systematic literature search of 5 databases (PubMed, MEDLINE, Embase, EconLit, and CINAHL) followed by a backward citation search was conducted in September 2022. Full-text, peer-reviewed articles in English including patients with high blood pressure (systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg) at baseline were included. Data from studies comparing at-home self-monitoring with clinical-setting monitoring alternatives were extracted, and the outcomes of interest included incremental cost-effectiveness and cost-utility ratios. Non-peer-reviewed studies or studies with pregnant women and children were excluded. To ensure accuracy and reliability, 2 authors independently evaluated all articles for eligibility and extracted relevant data from the selected articles. Findings Of 1607 articles identified from 5 databases, 16 studies met the inclusion criteria. Most studies were conducted in the US (6 [40%]) and in the UK (6 [40%]), and almost all studies (14 [90%]) used a health care insurance system perspective to determine costs. Nearly half the studies used quality-adjusted life-years gained and cost per 1-mm Hg reduction in blood pressure as outcomes. Overall, at-home blood pressure monitoring (HBPM) was found to be more cost-effective than monitoring in a clinical setting, particularly over a minimum 10-year time horizon. Among studies comparing HBPM alone vs 24-hour ambulatory blood pressure monitoring (ABPM) or HBPM combined with additional support or team-based care, the latter were found to be more cost-effective. Conclusions and Relevance In this systematic review, at-home blood pressure self-monitoring, particularly using automatic 24-hour continuous blood pressure measurements or combined with additional support or team-based care, demonstrated the potential to be cost-effective long-term compared with care in the physical clinical setting and could thus be prioritized for patients with hypertension from a cost-effectiveness standpoint.
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Affiliation(s)
- Michelle A. Hayek
- Population Informatics Lab, Department of Industrial and Systems Engineering, Texas A&M University, College Station
| | - Theodoros Giannouchos
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station
| | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station
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Holmstrand EC, Sato H, Li J, Mukherjee A, Fitzpatrick NE, Rayl KR, Colangelo FR. Digital hypertension management: clinical and cost outcomes of a pilot implementation of the OMRON hypertension management platform. Front Digit Health 2023; 5:1128553. [PMID: 37800090 PMCID: PMC10548242 DOI: 10.3389/fdgth.2023.1128553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Home monitoring of blood pressure (BP) in hypertensive patients can improve outcomes, but challenges to both patient compliance and the effective transmission of home BP readings to physicians can limit the extent to which physicians can use this information to improve care. The OMRON Hypertension Management Platform (OMRON HMP) pairs a home BP cuff with a digital product that tracks data, provides reminders to improve patient compliance, and provides a streamlined source of information to physicians. Objective The primary objective of the quality improvement (QI) project was to test the hypothesis that use of the OMRON HMP could reduce the number and cost of hypertension related claims, relative to a retrospectively matched cohort of insured members. A secondary objective was to demonstrate improvement in control of BP among patients. Design Eligible members were recruited to the QI project between December 1, 2018 and December 30, 2020 and data collected for six months following recruitment. All members received the OMRON HMP intervention. Setting Enrollment and data collection were coordinated on-site at selected PCP partner providers in Western Pennsylvania. Eligible members were identified from insurance claims data as those receiving care for primary hypertension from participating primary care physicians and/or cardiologists. Participants Eligible members were between the ages of 35 and 85, with a diagnosis of primary hypertension. The retrospective cohort was selected from electronic medical records of Highmark-insured patients with hypertension who received care at Allegheny Health Network (AHN), a subsidiary of Highmark Health. Members were matched on baseline BP and lipid measures, age, smoking status, diabetes status, race and sex. Intervention Daily home BP readings were recorded by the OMRON HMP app. Patient data was reviewed by clinical staff on a weekly basis and treatment plans could be adjusted in response to this data. Results OMRON HMP users showed a significant increase in the number and cost of hypertension-related claims, contrary to the hypothesis, but did display improvements in control of BP. Conclusions and Relevance The use of a digital platform to facilitate at-home BP monitoring appeared to improve BP control but led to increased hypertension-related costs in the short-term.
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Affiliation(s)
| | - Hironori Sato
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Jim Li
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Abhishek Mukherjee
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | | | - Kenneth R. Rayl
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | - Francis R. Colangelo
- Premier Medical Associates, Allegheny Health Network, Monroeville, PA, United States
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Tajeu GS, Tsipas S, Rakotz M, Wozniak G. Cost-Effectiveness of Recommendations From the Surgeon General's Call-to-Action to Control Hypertension. Am J Hypertens 2022; 35:225-231. [PMID: 34661634 DOI: 10.1093/ajh/hpab162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the United States, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of healthcare teams to manage hypertension, and to empower and equip patients to use self-measured BP monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General's recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.
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Affiliation(s)
- Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, Pennsylvania, USA
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Shantharam SS, Mahalingam M, Rasool A, Reynolds JA, Bhuiya AR, Satchell TD, Chapel JM, Hawkins NA, Jones CD, Jacob V, Hopkins DP. Systematic Review of Self-Measured Blood Pressure Monitoring With Support: Intervention Effectiveness and Cost. Am J Prev Med 2022; 62:285-298. [PMID: 34686388 PMCID: PMC8748385 DOI: 10.1016/j.amepre.2021.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Self-measured blood pressure monitoring with support is an evidence-based intervention that helps patients control their blood pressure. This systematic economic review describes how certain intervention aspects contribute to effectiveness, intervention cost, and intervention cost per unit of the effectiveness of self-measured blood pressure monitoring with support. METHODS Papers published between data inception and March 2021 were identified from a database search and manual searches. Papers were included if they focused on self-measured blood pressure monitoring with support and reported blood pressure change and intervention cost. Papers focused on preeclampsia, kidney disease, or drug efficacy were excluded. Quality of estimates was assessed for effectiveness, cost, and cost per unit of effectiveness. Patient characteristics and intervention features were analyzed in 2021 to determine how they impacted effectiveness, intervention cost, and intervention cost per unit of effectiveness. RESULTS A total of 22 studies were included in this review from papers identified in the search. Type of support was not associated with differences in cost and cost per unit of effectiveness. Lower cost and cost per unit of effectiveness were achieved with simple technologies such as interactive phone systems, smartphones, and websites and where providers interacted with patients only as needed. DISCUSSION Some of the included studies provided only limited information on key outcomes of interest to this review. However, the strength of this review is the systematic collection and synthesis of evidence that revealed the associations between the characteristics of implemented interventions and their patients and the interventions' effectiveness and cost, a useful contribution to the fields of both research and implementation.
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Affiliation(s)
- Sharada S Shantharam
- IHRC, Inc., Atlanta, Georgia; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mallika Mahalingam
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Aysha Rasool
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Jeffrey A Reynolds
- Karna, LLC, Atlanta, Georgia; Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aunima R Bhuiya
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Tyra D Satchell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - John M Chapel
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Nikki A Hawkins
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D Jones
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Verughese Jacob
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jarvis H, Oprinovich S, Guthrie K. Implementation of a self-measured blood pressure program in a community pharmacy: A pilot study. J Am Pharm Assoc (2003) 2021; 62:S41-S46.e1. [PMID: 34848164 DOI: 10.1016/j.japh.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular disease in the United States and is costing the health care system billions of dollars annually. A health program that combines education, empowerment, and monitoring has shown to improve clinical outcomes and decrease overall health care costs. OBJECTIVE To describe the implementation and effectiveness of a self-measured blood pressure (SMBP) program in a community pharmacy. PRACTICE DESCRIPTION An independent community pharmacy located within rural Southeast Missouri. On-site community pharmacists provide medication therapy management, adherence monitoring, immunizations, and reimbursed clinical services. PRACTICE INNOVATION Patients were eligible if they were older than 18 years of age and fell into one of the following categories: self-reported a new hypertension diagnosis, self-reported a desire to SMBP, were referred by a provider, or had a medication change within the 3 months before enrollment. The program consisted of 4 patient sessions. The first session obtained an initial blood pressure and provided patient education and behavior counseling. Follow-up sessions obtained average SMBP readings and reinforced previously learned concepts. EVALUATION METHODS Implementation was evaluated using time and patient satisfaction. Effectiveness was evaluated using number and type of clinical problems identified, BP measurements, and test scores. RESULTS A total of 20 patients enrolled and completed the study. The program took 63 minutes (SD ± 18) of staff time per patient for recruitment, sessions, reminder calls, and documentation. All patients received education and monitoring and 11 additional clinical problems were documented. Systolic BP decreased an average of 17 mm Hg (P = 0.002), and diastolic BP decreased an average of 12 mm Hg (P < 0.001). Patient confidence scores increased by 14%, and 7 more patients correctly answered the post-test knowledge question. All patients reported overall satisfaction with the program as "satisfied" or "very satisfied." CONCLUSION This standardized SMBP program effectively improved hypertension control and patient confidence in managing BP.
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Pinto RD, Monaco A, Ortu E, Czesnikiewicz-Guzik M, Aguilera EM, Giannoni M, D'Aiuto F, Guzik TJ, Ferri C, Pietropaoli D. Access to dental care and blood pressure profiles in adults with high socioeconomic status. J Periodontol 2021; 93:1060-1071. [PMID: 34726790 PMCID: PMC9542004 DOI: 10.1002/jper.21-0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
Background Reduced access to dental care may increase cardiovascular risk; however, socioeconomic factors are believed to confound the associations. We hypothesized that the relation persists despite economic wellness and high education, with reduced access to dental care affecting cardiovascular risk at least in part through its effect on blood pressure (BP), possibly mediated by systemic inflammation. Methods We first assessed the sociodemographic and clinical characteristics related to last dental visit timing (≤ or >6 months; self‐reported) using national representative cross‐sectional data. Then, the association of last dental visit timing with clinic BP was selectively investigated in highly educated, high income participants, further matched for residual demographic and clinical confounders using propensity score matching (PSM). The mediating effect of systemic inflammation was formally tested. Machine learning was implemented to investigate the added value of dental visits in predicting high BP over the variables included in the Framingham Hypertension Risk Score among individuals without an established diagnosis of hypertension. Results Of 27,725 participants included in the population analysis, 46% attended a dental visit ≤6 months. In the PSM cohort (n = 2350), last dental visit attendance >6 months was consistently associated with 2 mmHg higher systolic BP (P = 0.001) and with 23 to 35% higher odds of high/uncontrolled BP compared with attendance ≤6 months. Inflammation mildly mediated the association. Access to dental care improved the prediction of high BP by 2%. Conclusions Dental care use impacts on BP profiles independent of socioeconomic confounders, possibly through systemic inflammation. Regular dental visits may contribute to preventive medicine.
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Affiliation(s)
- Rita Del Pinto
- Unit of Internal Medicine and Nephrology - Center for Hypertension and Cardiovascular Prevention - San Salvatore Hospital - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy.,Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Annalisa Monaco
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Eleonora Ortu
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK.,Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Eva Muñoz Aguilera
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Mario Giannoni
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Internal and Agricultural Medicine, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Claudio Ferri
- Unit of Internal Medicine and Nephrology - Center for Hypertension and Cardiovascular Prevention - San Salvatore Hospital - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy.,Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Davide Pietropaoli
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
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Arrieta A, Woods J, Wozniak G, Tsipas S, Rakotz M, Jay S. Return on investment of self-measured blood pressure is associated with its use in preventing false diagnoses, not monitoring hypertension. PLoS One 2021; 16:e0252701. [PMID: 34143817 PMCID: PMC8213192 DOI: 10.1371/journal.pone.0252701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/20/2021] [Indexed: 01/14/2023] Open
Abstract
Previous research indicates that patient self-measured blood pressure (SMBP) is a cost-effective strategy for improving hypertension (HTN) diagnosis and control. However, it is unknown which specific uses of SMBP produce the most value. Our goal is to estimate, from an insurance perspective, the return-on-investment (ROI) and net present value associated with coverage of SMBP devices when used (a) only to diagnose HTN, (b) only to select and titrate medication, (c) only to monitor HTN treatment, or (d) as a bundle with all three uses combined. We employed national sample of claims data, Framingham risk predictions, and published sensitivity-specificity values of SMBP and clinic blood-pressure measurement to extend a previously-developed local decision-analytic simulation model. We then used the extended model to determine which uses of SMBP produce the most economic value when scaled to the U.S. adult population. We found that coverage of SMBP devices yielded positive ROIs for insurers in the short-run and at lifetime horizon when the three uses of SMBP were considered together. When each use was evaluated separately, positive returns were seen when SMBP was used for diagnosis or for medication selection and titration. However, returns were negative when SMBP was used exclusively to monitor HTN treatment. When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million false positive HTN diagnoses, thereby improving quality of care while saving insurance plans $254 per member. A strong economic case exists for insurers to cover the cost of SMBP devices, but it matters how devices are used.
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Affiliation(s)
- Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - John Woods
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stavros Tsipas
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Michael Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stephen Jay
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Current Issues of Purpose and Control of Antihypertensive Therapy in Outpatient Practice (Clinical Case). Fam Med 2021. [DOI: 10.30841/2307-5112.1.2021.231937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The World Health Organization identifies hypertension (AH) as «the world’s leading global risk of increased mortality from cardiovascular disease». AH is one of the most serious health problems because of its prevalence and importance. Caring for a patient with AH with or without chronic comorbidity requires a long-term holistic, patient-centered approach. The goal of treating a patient with AH is to reduce the overall cardiovascular risk, notu jst to control blood pressure.
The aim is to analyze the possibilities of basic drug therapy and control over its implementation in patients with hypertension in different clinical situations in the practice of a family physician.
Newly detected AH in a patient requires careful examination and appointment of effective comprehensive treatment. The tactics of selection of antihypertensive treatment for a patient with newly diagnosed hypertension are considered on a clinical example. Improving lifestyle and healthy living habits are necessary for all patients with AH, even when antihypertensive medication is mandatory. It is important to regulate blood pressure. The choice of medication depends on the patient’s characteristics and comorbidities.
Care of a patient with hypertension should be carried out holistically with the identification and control of additional risk factors and complications, in parallel with the control of hypertension. At the same time it is necessary to take care of the treatment of some other somatic diseases or mental disorders that may affect the outcome of treatment of hypertension.
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Factors influencing home blood pressure monitor ownership in a large clinical trial. J Hum Hypertens 2021; 36:325-332. [PMID: 33654240 PMCID: PMC8930760 DOI: 10.1038/s41371-021-00511-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022]
Abstract
Home blood pressure monitor (HBPM) ownership prevalence and the factors that influence it are unclear. This study aimed to investigate factors associated with HBPM ownership among participants in the Treatment in Morning versus Evening (TIME) hypertension study. This study is a sub-analysis of the TIME study, a randomised trial investigating the effect of day-time versus night-time dosing of antihypertensive medication on cardiovascular outcomes in adults with hypertension. As part of the TIME study online registration process, participants were asked to indicate whether they owned an HBPM. A multivariable logistic regression model was constructed to determine factors associated with HBPM ownership. Of 21,104 randomised participants, 11,434 (54.2%) reported owning an HBPM. The mean age of all participants at enrolment was 67.7 ± 9.3 years, 12,134 (57.5%) were male, and 8892 (42.1%) reported a current or previous history of smoking. Factors associated with an increased likelihood of reporting HBPM owned include being male (OR:1.47; 95% CI 1.39–1.56) or residing in a less deprived socioeconomic region (IMD Decile 6–10) (OR:1.31; 95% CI 1.23–1.40). Participants with a history of diabetes mellitus (OR:0.74; 95% CI:0.64–0.86) or current smokers, compared to non-smokers, (OR:0.71; 95% CI:0.62–0.82) were less likely to report owning an HBPM. This study has identified important patient factors influencing HBPM ownership. Further qualitative research would be valuable to identify and explore potential patient-level barriers to engagement with self-monitoring of blood pressure.
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Takura T, Hirano Goto K, Honda A. Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases. BMC Med 2021; 19:15. [PMID: 33413377 PMCID: PMC7792071 DOI: 10.1186/s12916-020-01874-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Medical costs and the burden associated with cardiovascular disease are on the rise. Therefore, to improve the overall economy and quality assessment of the healthcare system, we developed a predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes. METHODS This study used information from a large-scale database on health insurance claims, long-term care insurance, and health check-ups. Participants comprised patients who received inpatient medical care for diseases of the circulatory system (ICD-10 codes I00-I99). The predictive model used broadly defined composite adherence as the explanatory variable and medical and long-term care costs as the objective variable. Predictive models used random forest learning (AI: artificial intelligence) to adjust for predictors, and multiple regression analysis to construct ASHRO scores. The ability of discrimination and calibration of the prediction model were evaluated using the area under the curve and the Hosmer-Lemeshow test. We compared the overall mortality of the two ASHRO 50% cut-off groups adjusted for clinical risk factors by propensity score matching over a 48-month follow-up period. RESULTS Overall, 48,456 patients were discharged from the hospital with cardiovascular disease (mean age, 68.3 ± 9.9 years; male, 61.9%). The broad adherence score classification, adjusted as an index of the predictive model by machine learning, was an index of eight: secondary prevention, rehabilitation intensity, guidance, proportion of days covered, overlapping outpatient visits/clinical laboratory and physiological tests, medical attendance, and generic drug rate. Multiple regression analysis showed an overall coefficient of determination of 0.313 (p < 0.001). Logistic regression analysis with cut-off values of 50% and 25%/75% for medical and long-term care costs showed that the overall coefficient of determination was statistically significant (p < 0.001). The score of ASHRO was associated with the incidence of all deaths between the two 50% cut-off groups (2% vs. 7%; p < 0.001). CONCLUSIONS ASHRO accurately predicted future integrated healthcare resource consumption and was associated with clinical outcomes. It can be a valuable tool for evaluating the economic usefulness of individual adherence behaviours and optimising clinical outcomes.
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Affiliation(s)
- Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keiko Hirano Goto
- Department of Cardiovascular Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Asao Honda
- Saitama Inst. of Public Health, Saitama, Japan
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Blok S, van der Linden EL, Somsen GA, Tulevski II, Winter MM, van den Born BJH. Success factors in high-effect, low-cost eHealth programs for patients with hypertension: a systematic review and meta-analysis. Eur J Prev Cardiol 2020; 28:1579-1587. [DOI: 10.1177/2047487320957170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022]
Abstract
Background eHealth programs can lower blood pressure but also drive healthcare costs. This study aims to review the evidence on the effectiveness and costs of eHealth for hypertension and assess commonalities in programs with high effect and low additional cost. Results Overall, the incremental decrease in systolic blood pressure using eHealth, compared to usual care, was 3.87 (95% confidence interval (CI) 2.98–4.77) mmHg at 6 months and 5.68 (95% CI 4.77–6.59) mmHg at 12 months’ follow-up. High intensity interventions were more effective, resulting in a 2.6 (95% CI 0.5–4.7) (at 6 months) and 3.3 (95% CI 1.4–5.1) (at 12 months) lower systolic blood pressure, but were also more costly, resulting in €170 (95% CI 56–284) higher costs at 6 months and €342 (95% CI 128–556) at 12 months. Programs that included a high volume of participants showed €203 (95% CI 99–307) less costs than those with a low volume at 6 months, and €525 (95% CI 299–751) at 12 months without showing a difference in systolic blood pressure. Studies that implemented eHealth as a partial replacement, rather than addition to usual care, were also less costly (€119 (95% CI –38–201 at 6 months) and €346 (95% CI 261–430 at 12 months)) without being less effective. Evidence on eHealth programs for hypertension is ambiguous, heterogeneity on effectiveness and costs is high ( I2 = 56–98%). Conclusion Effective eHealth with limited additional costs should focus on high intensity interventions, involve a large number of participants and use eHealth as a partial replacement for usual care.
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Affiliation(s)
- Sebastiaan Blok
- Department of Cardiology, Cardiology Centers of the Netherlands, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Internal and Vascular Medicine, The Netherlands
| | - Eva L van der Linden
- Amsterdam UMC, University of Amsterdam, Department of Internal and Vascular Medicine, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public Health, The Netherlands
| | - G Aernout Somsen
- Department of Cardiology, Cardiology Centers of the Netherlands, The Netherlands
| | - Igor I Tulevski
- Department of Cardiology, Cardiology Centers of the Netherlands, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Cardiology Centers of the Netherlands, The Netherlands
- Department of Cardiology, University of Amsterdam, The NetherlandsAmsterdam UMC, University of Amsterdam, Department of Cardiology, The Netherlands
| | - Bert-Jan H van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal and Vascular Medicine, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public Health, The Netherlands
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13
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Margolis KL, Dehmer SP, Sperl-Hillen J, O'Connor PJ, Asche SE, Bergdall AR, Green BB, Nyboer RA, Pawloski PA, Trower NK, Maciosek MV. Cardiovascular Events and Costs With Home Blood Pressure Telemonitoring and Pharmacist Management for Uncontrolled Hypertension. Hypertension 2020; 76:1097-1103. [PMID: 32862713 DOI: 10.1161/hypertensionaha.120.15492] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Uncontrolled hypertension is a leading contributor to cardiovascular disease. A cluster-randomized trial in 16 primary care clinics showed that 12 months of home blood pressure telemonitoring and pharmacist management lowered blood pressure more than usual care (UC) for 24 months. We report cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death) and costs over 5 years of follow-up. In the telemonitoring intervention (TI group, n=228), there were 15 cardiovascular events (5 myocardial infarction, 4 stroke, 5 heart failure, 1 cardiovascular death) among 10 patients. In UC group (n=222), there were 26 events (11 myocardial infarction, 12 stroke, 3 heart failure) among 19 patients. The cardiovascular composite end point incidence was 4.4% in the TI group versus 8.6% in the UC group (odds ratio, 0.49 [95% CI, 0.21-1.13], P=0.09). Including 2 coronary revascularizations in the TI group and 10 in the UC group, the secondary cardiovascular composite end point incidence was 5.3% in the TI group versus 10.4% in the UC group (odds ratio, 0.48 [95% CI, 0.22-1.08], P=0.08). Microsimulation modeling showed the difference in events far exceeded predictions based on observed blood pressure. Intervention costs (in 2017 US dollars) were $1511 per patient. Over 5 years, estimated event costs were $758 000 in the TI group and $1 538 000 in the UC group for a return on investment of 126% and a net cost savings of about $1900 per patient. Telemonitoring with pharmacist management lowered blood pressure and may have reduced costs by avoiding cardiovascular events over 5 years. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00781365.
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Affiliation(s)
- Karen L Margolis
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Steven P Dehmer
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - JoAnn Sperl-Hillen
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Patrick J O'Connor
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Stephen E Asche
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Anna R Bergdall
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (B.B.G.)
| | - Rachel A Nyboer
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Pamala A Pawloski
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Nicole K Trower
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
| | - Michael V Maciosek
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
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14
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Stupplebeen DA, Pirkle CM, Sentell TL, Nett BMI, Ilagan LSK, Juan B, Medeiros J, Keliikoa LB. Self-Measured Blood Pressure Monitoring: Program Planning, Implementation, and Lessons Learned From 5 Federally Qualified Health Centers in Hawai'i. Prev Chronic Dis 2020; 17:E47. [PMID: 32584755 PMCID: PMC7316413 DOI: 10.5888/pcd17.190348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Self-measured blood pressure monitoring programs (BPMPs) are effective at controlling hypertension. We examined implementation of self-measured BPMPs at 5 Hawaiʻi-based Federally Qualified Health Centers (FQHCs). In a process evaluation of these programs, we found that FQHCs developed protocols for self-measured BPMP recruitment and enrollment and provided additional supports to account for their patients’ psychosocial needs to achieve blood pressure control, such as lifestyle change education and opportunities through referrals either to on-site or other programs (eg, on-site gym, tobacco cessation program). Common barriers across sites included insufficient material support for blood pressure monitors and data collection; funding, which affects program sustainability; and the lack of an “off-the-shelf” self-measured BPMP intervention. Policy makers and funding organizations should address these issues related to self-measured BPMPs to ensure implementation success.
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Affiliation(s)
- David A Stupplebeen
- Healthy Hawai'i Initiative Evaluation Team, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii.,Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed D-210, Honolulu, HI 96822.
| | - Catherine M Pirkle
- Healthy Hawai'i Initiative Evaluation Team, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Tetine L Sentell
- Healthy Hawai'i Initiative Evaluation Team, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Blythe M I Nett
- Chronic Disease Prevention and Health Promotion Division, Hawai'i State Department of Health, Kapolei, Hawaii
| | - Lindsey S K Ilagan
- Chronic Disease Prevention and Health Promotion Division, Hawai'i State Department of Health, Kapolei, Hawaii
| | - Bryan Juan
- Hawai'i Primary Care Association, Honolulu, Hawaii
| | | | - L Brooke Keliikoa
- Healthy Hawai'i Initiative Evaluation Team, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii
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Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation 2020; 142:e42-e63. [PMID: 32567342 DOI: 10.1161/cir.0000000000000803] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
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16
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Affiliation(s)
- Lawrence R Krakoff
- From the Lauder Cardiovascular Center, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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17
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Kario K, Shimbo D, Hoshide S, Wang JG, Asayama K, Ohkubo T, Imai Y, McManus RJ, Kollias A, Niiranen TJ, Parati G, Williams B, Weber MA, Vongpatanasin W, Muntner P, Stergiou GS. Emergence of Home Blood Pressure-Guided Management of Hypertension Based on Global Evidence. Hypertension 2019; 74:229-236. [PMID: 31256719 PMCID: PMC6635060 DOI: 10.1161/hypertensionaha.119.12630] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H.),Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Tokyo, Japan (K.K., S.H., J.-G.W.)
| | - Daichi Shimbo
- The Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
| | - Satoshi Hoshide
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H.),Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Tokyo, Japan (K.K., S.H., J.-G.W.)
| | - Ji-Guang Wang
- Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Tokyo, Japan (K.K., S.H., J.-G.W.),Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (Y.I.)
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (R.J.M.)
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (A.K., G.S.S.)
| | - Teemu J. Niiranen
- National Institute for Health and Welfare, and Department of Medicine, University of Turku and Turku University Hospital, Finland (T.J.N.)
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.),Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milano, Italy (G.P.)
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, United Kingdom (B.W.)
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.)
| | - Wanpen Vongpatanasin
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (P.M.)
| | - George S. Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (A.K., G.S.S.)
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18
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Photoplethysmography-Based Continuous Systolic Blood Pressure Estimation Method for Low Processing Power Wearable Devices. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9112236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Regardless of age, it is always important to detect deviations in long-term blood pressure from normal levels. Continuous monitoring of blood pressure throughout the day is even more important for elderly people with cardiovascular diseases or a high risk of stroke. The traditional cuff-based method for blood pressure measurements is not suitable for continuous real-time applications and is very uncomfortable. To address this problem, continuous blood pressure measurement methods based on photoplethysmogram (PPG) have been developed. However, these methods use specialized high-performance hardware and sensors, which are not available for common users. This paper proposes the continuous systolic blood pressure (SBP) estimation method based on PPG pulse wave steepness for low processing power wearable devices and evaluates its suitability using the commercially available CMS50FW Pulse Oximeter. The SBP estimation is done based on the PPG pulse wave steepness (rising edge angle) because it is highly correlated with systolic blood pressure. The SBP estimation based on this single feature allows us to significantly reduce the amount of data processed and avoid errors, due to PPG pulse wave amplitude changes resulting from physiological or external factors. The experimental evaluation shows that the proposed SBP estimation method allows the use of off-the-shelf wearable PPG measurement devices with a low sampling rate (up to 60 Hz) and low resolution (up to 8-bit) for precise SBP measurements (mean difference MD = −0.043 and standard deviation SD = 6.79). In contrast, the known methods for continuous SBP estimation are based on equipment with a much higher sampling rate and better resolution characteristics.
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Cuffee YL, Sciamanna C, Gerin W, Lehman E, Cover L, Johnson AA, Pool A, Yang C. The Effectiveness of Home Blood Pressure on 24-Hour Blood Pressure Control: A Randomized Controlled Trial. Am J Hypertens 2019; 32:186-192. [PMID: 30371759 PMCID: PMC6361075 DOI: 10.1093/ajh/hpy160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/29/2018] [Accepted: 10/26/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring (HBPM) is cited as an effective approach for improving blood pressure control. The objective of this study was to determine the effectiveness of HBPM combined with a health education session in reducing blood pressure and improving medication adherence among adults with hypertension. METHODS Two hundred thirteen participants were enrolled in a 3-month study and randomized to receive HBPM or usual care. Participants were also randomized to receive an educational session delivered using a pamphlet or a computer-based program. Topics of the educational session included preventing hypertension, managing weight, staying active, and cutting down on salt and fat. RESULTS At the 3-month follow-up, there was a reduction in ambulatory blood pressure among the HBPM group. However, the differences found within the HBPM group were no greater than those found among the control group. We did not detect a statistically significant difference in adherence to medication when comparing the HBPM to the usual care group. CONCLUSIONS HBPM and educational session did not lower blood pressure or improve medication adherence in our sample. A greater effect may have been seen if coupled with an enhanced educational intervention and if blood pressure measures were shared with the provided. The findings of this study provide useful insights for future HBPM studies.
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Affiliation(s)
- Yendelela L Cuffee
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lindsay Cover
- Levine Children’s Hospital, Atrium Health, Charlotte, NC, USA
| | - Andrea A Johnson
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andy Pool
- Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chengwu Yang
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, USA
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Clinical Implementation of Self-Measured Blood Pressure Monitoring, 2015-2016. Am J Prev Med 2019; 56:e13-e21. [PMID: 30337237 PMCID: PMC6485411 DOI: 10.1016/j.amepre.2018.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/10/2018] [Accepted: 06/04/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Self-measured blood pressure monitoring (SMBP) plus additional clinical support is an evidence-based strategy that improves blood pressure control. Despite national recommendations for SMBP use and potential cost savings, insurance coverage for implementation is limited in the U.S. and little is known regarding clinical implementation. METHODS In 2017, using 2015 and 2016 DocStyles survey data from 1,590 primary care physicians and nurse practitioners in U.S. outpatient facilities, SMBP-related clinical practices and provider roles were assessed. RESULTS Almost all (97%) respondents reported using SMBP. Among 1,539 who used SMBP, more than half (60%) used SMBP for a combination of diagnostic and treatment purposes, whereas 24% used SMBP for diagnosis only and 16% used SMBP for treatment only. The most common methods for patients to share SMBP results with clinical staff were paper log (68%); during appointments (66%); by telephone (37%); by secure website (22%); or by secure e-mail (19%). Nearly all (98%) respondents reported that medication adjustments were provided to patients based on SMBP readings. About 15% did not counsel patients regarding cuff size, and 8% did not validate patient devices. Only 13% of respondents reported having monitor loaner programs, and availability did not vary by the financial status of the patient population (p=0.59). CONCLUSIONS SMBP is used widely in outpatient facilities as reported in the survey, although provider roles and SMBP-related practices vary, and gaps exist regarding patient counseling, device validation, and loaner program availability. As part of efforts to improve hypertension control, healthcare professionals can promote increased use of best practices for SMBP, whereas insurers can implement standardization and support of SMBP.
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Galiatsatos P, Haapanen KA, Nelson K, Park A, Sherwin H, Robertson M, Sheets K, Hale WD. Sociodemographic Factors Associated with Types of Projects Implemented by Volunteer Lay Health Educators in Their Congregations. JOURNAL OF RELIGION AND HEALTH 2018; 57:1771-1778. [PMID: 29992475 DOI: 10.1007/s10943-018-0669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study focused on the association between type of community health interventions and lay health educator variables. Lay health educators are volunteers from local faith communities who complete a healthcare training program, taught by physicians in-training. Lay health educators are instructed to implement health-related initiatives in their respective communities after graduation. Of the 72 graduates since 2011, we surveyed 55 lay health educators to gain insight into their involvement with their congregation and the type of health projects they have implemented. We dichotomized the health projects into "raising awareness" and "teaching new health skills." Using adjusted logistic regression models, variables associated with implementing health projects aimed at teaching health skills included length of time as a member of their congregation, current employment, and age. These results may help future programs prepare lay health community educators for the type of health interventions they intend to implement in their respective communities.
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Affiliation(s)
- Panagis Galiatsatos
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | | | - Katie Nelson
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Ashley Park
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Hasmin Sherwin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Mariah Robertson
- Department of Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kerry Sheets
- Department of Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - W Daniel Hale
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
- Division of Geriatrics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Chattopadhyay SK, Jacob V, Mercer SL, Hopkins DP, Elder RW, Jones CD. Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings. Am J Prev Med 2017; 53:S155-S163. [PMID: 29153116 PMCID: PMC6173312 DOI: 10.1016/j.amepre.2017.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 10/18/2022]
Abstract
The Community Preventive Services Task Force recommended five interventions for cardiovascular disease prevention between 2012 and 2015. Systematic economic reviews of these interventions faced challenges that made it difficult to generate meaningful policy and programmatic conclusions. This paper describes the methods used to assess, synthesize, and evaluate the economic evidence to generate reliable and useful economic conclusions and address the comparability of economic findings across interventions. Specifically, steps were taken to assess completeness of data and identify the components and drivers of cost and benefit. Except for the intervention cost of self-measured blood pressure monitoring intervention, either alone or with patient support, all cost and benefit estimates were standardized as per patient per year. When possible, intermediate outcomes were converted to quality-adjusted life year. Differences within and between interventions were considered to generate economic conclusions and inform their comparability. The literature search period varied among interventions. This analysis was completed in 2016. Although team-based care, self-measured blood pressure monitoring with patient support, and self-measured blood pressure monitoring within team-based care were found to be cost effective, their cost-effectiveness estimates were not comparable because of differences in the intervention characteristics. Lack of enough data or incomplete information made it difficult to reach an overall economic finding for the other interventions. The Community Guide methods discussed here may help others conducting systematic economic reviews of public health interventions to respond to challenges with the synthesis of evidence and provide useful findings for public health decision makers.
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Affiliation(s)
- Sajal K Chattopadhyay
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Verughese Jacob
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shawna L Mercer
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Randy W Elder
- Office of Science Quality, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D Jones
- Division for Heart Disease and Stroke Prevention, Office of Noncommunicable Diseases, Injury, and Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Task Force CPS. Self-Measured Blood Pressure Monitoring Improves Outcomes: Recommendation of the Community Preventive Services Task Force. Am J Prev Med 2017; 53:e115-e118. [PMID: 28818278 DOI: 10.1016/j.amepre.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 02/04/2023]
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