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

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.