Integrating Home Blood Pressure Monitoring into Primary Care Practice: A Pilot Study

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1 Integrating Home Blood Pressure Monitoring into Primary Care Practice: A Pilot Study Barbara Holloway, RN, BSN, CDE Elizabeth Ciemins, PhD, MPH, MA March 12, 2016

2 About Us Quality care is delivered by approximately 4,000 employees, including more than 400 physicians and advanced practitioners offering more than 50 specialties. Community governed, not-for-profit 304 licensed-bed acute care hospital Level II Emergency & Trauma Center 90 bed long-term care facility 43 county service area - 127,801 square miles 12 regional partnerships

3 Study Objective To improve the monitoring, management, and control of hypertension by: identifying high risk patients with the diagnosis of hypertension; engaging patients in discussion and education about their disease; promoting self monitoring using an automated wireless blood pressure measurement device; expanding the use of the EHR to manage disease

4 Specific Aims Aim 1: Identify patients with newly diagnosed or uncontrolled hypertension, engage patients in disease management education, and to supply patients with an electronic, wireless oscillometric monitor for home blood pressure measurements. Aim 2: Retrieve the automatic blood pressure reading values from the device manufacturer s data base, and alert the patient s primary care provider of any out of range values.

5 Methods Recruit 37 patients Provide education and home monitors Follow patients for 4-7 months Assess blood pressure change over time Monitor provider behavior through chart review Survey patients on ease of use, perceived effect on outcomes, engagement, and perceived quality and accuracy of device

6 Recruitment and Workflow Recruitment sources for 37 participants: 24 primary care provider 1 Billings Clinic newsletter 6 Employee Board notification 5 calls to patients with HTN with scheduled office visit 1 physician self-referred RN navigator interviewed and educated prospective participants and issued monitors Reviewed Withings site once per week and noted the high, low and median values

7 Recruitment and Workflow (cont.) Readings sent to nurse practitioner (NP) NP determined if PCP should be notified NP provided f/u appointment date if applicable RN navigator fielded questions from participants, called to remind to take BPs more often if appropriate, or provided technical assistance or education

8 Demographics (n=37) Measure mean range Age (years) BMI (kg/m 2 ) Length in Study (months) n % Female White Hypertension Diagnosis Diabetes Diagnosis 5 14 Chronic Kidney Disease Diagnosis 3 8

9

10 Provider Plan Hypertension Medication Action n (%) Started or added medication 13 (35) Increased dose 8 (22) Decreased dose 3 (8) Discontinued medication 7 (19) Lifestyle Change Action n (%) Instructed participant to return for nurse re-check 16 (43) DASH or other diet plan? 25 (68) Recommended weight loss, exercise or other lifestyle changes 25 (68) Referrals n (%) Specialist for HTM management 1 (3) Dietitian, Educator, or other care provider 2 (5)

11

12 Blood Pressure Control Baseline Study Completion Controlled BP 51% 68% Definition of Controlled Blood Pressure: < 140/90 < 150/90, if age 60+

13 DIFFERENCES IN BLOOD PRESSURE BY GENDER SYSTOLIC BEGINNING SYSTOLIC ENDING SYSTOLIC DIFFERENCE GENDER FEMALE n = MALE n = TOTAL n = DIFFERENCES IN BLOOD PRESSURE BY AGE SYSTOLIC BEGINNING SYSTOLIC ENDING SYSTOLIC DIFFERENCE AGE GROUP YO n = YO n = YO n =

14 Patient Survey Perceived Ease of Use PRE POST Confidence in Ability to Use or Having Used the Device Correctly Device Will Be, or Was, Easy for Patient to Use The Instructions I Received on How to Use the Device Were Comprehensive I Learned How to Use the Device Connecting the Device to the Phone Will Be, or Was, Easy for Me to Do Perceived Effect on Outcomes Device Will, or Did, Improve Patient's Ability to Monitor and Control Blood Pressure Use of the Device Will Enhance, or Is Enhancing, the Ability of My Provider and me to Improve my Blood Pressure Control * I Will, or Did, See Improvements in My Blood Pressure Through Using the Device I Will, or Am, Monitoring Blood Pressure More Often with the Device * 1 = Strongly Disagree, 5 = Strongly Agree

15 Patient Survey (cont.) Effect on Patient Engagement I Will, or Do, Feel More Confident in My Provider's Ability to Help Me Control My Blood Pressure Once Using the Monitor Use of the Device Will, or Did, Improve Communications with My Provider Regarding My Blood Pressure I Will, or Do, Feel More Comfortable in My Ability to Improve My Health Through Using the Device PRE POST * * The Device Will, or Did, Improve My Motivation to Try to Control My Blood Pressure Perceived Quality and Accuracy of Product Blood Pressure Results Obtained Through the Device Will Be, or Were, About What Was Expected The Device Will, or Does, Give Me Clear Feedback on My Blood Pressure Level I Expect to, or Do, Recommend the Device to People Who Are Trying to Monitor Their Blood Pressure Level Use of the Device Will Not, or Did Not, Intrude On or Disrupt My Personal Life The Blood Pressure Results Obtained Through the Device Will Be, or Were, Clear = Strongly Disagree, 5 = Strongly Agree

16 COMMENTS BY AGE GROUP s n= s n= s n=10 Liked it, learned about the affect of exercise and some foods on BP readings - kept Stated she loved monitor - sporadic use - kept Loves it, working with MD, no problems - kept Called MD to get a med changed - kept Trouble when got a new android until site was updated. - kept "It helped different providers to finally Takes phone in to MD - states MD collaborate about the wide variations in now interested in talking about my BP and management - kept Thought it very beneficial and wants to keep the monitor - kept Liked it - kept works well, helpful - kept Loves the monitor, found PCP not real responsive to her information and questions regarding BP management, - changing PCP - kept On button is too small for large hands otherwise likes it. Credits study with saving his life - kept Loves the monitor, Working well, no problems. - Kept my readings. I'm in better control" - kept Used in collaboration with PCP, led to a med change. - kept Used in collaboration with PCP, led to a med change. Lost weight and noticed the effect on her BP. - kept Used in collaboration with PCP. "Managed my meds this way". - kept

17 COMMENTS BY AGE GROUP (cont.) s n= s n= s n=10 Once in awhile had trouble getting a reading Could have been positioned wrong. - kept States it read too high all the time - preferred old monitor with large cuff. Never could figure out how to use it. We found no problem, turned it in early Had to resync with phone every time. BP readings did not show up in phone. Turned monitor in early Large muscular arms, unable to get it to work on him Travels a lot, too bulky to take, or not good Wi-Fi (Mexico). Need to improve the battery connection system. On button hard to push - kept Hated it, "too time consuming, had to be too careful not to move" Glad to get rid of it. "Errors too often." Battery runs down very fast. "Too fussy". Likes old monitor better. "Too complicated". Had trouble navigating the app on his phone.

18 Participant Comments Likes Asked to keep the meter and continue to work with PCP (n=25) Learned what effect exercise, food, or stress has on BP Reported PCP more responsive to discussing HTN and problem-solve with them Dislikes Did not trust readings Trouble with app or Bluetooth C/O pain with readings Trouble with reading errors or monitor stopping often Green light had to be manually turned off Batteries did not hold charge Button too small for large hands.

19 Success Story #1 68 yo female Could not convince PCP about her widely fluctuating BP values (108/60 184/87) Took her phone in to office visit with the Withings graph Convinced PCP to order a specialist consultation and problem-solve with patient

20 Success Story #2 59 yo male Surprised by extreme readings on intake Sent home with monitor & told to check several more times and call PCP if high readings continued Found that his medication bottle had been filled with a statin at the pharmacy Corrections made and he is very happy with the monitor.

21 Summary Home monitoring has the potential to improve HTN management among patients with uncontrolled or newly diagnosed HTN Technology needs to be easy to use and operate, and integrated into local EHR Home monitoring has the potential to improve provider-patient engagement in HTN management

22 Questions? Barbara Holloway:

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