Population Informatics Lab, Texas A&M University, College Station, TX, United States.
Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.
J Med Internet Res. 2021 Sep 6;23(9):e29018. doi: 10.2196/29018.
Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems.
The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control.
This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days.
The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort.
Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence.
美国近 50%的成年人患有高血压。虽然临床试验表明家庭血压监测在管理高血压方面可能有效，但由于患者依从性问题，报告的结果可能无法实现。
本研究旨在描述医疗补助患者对日常远程监测的依从性，确定依从性提醒电话的影响，并调查与血压控制的关联。
本研究针对来自德克萨斯州的医疗补助高血压患者。分析了一家远程监测公司 2016 年至 2018 年的 180 天血压和脉搏数据，以评估平均传输率和平均血压变化。前 30 天的数据因启动效应而被排除。方案要求患者每天在特定时间传输读数。未传输读数的患者会收到依从性提醒电话，以解决问题并鼓励传输。患者被分为依从性和非依从性队列；依从性队列是指至少传输数据 80%天数的患者。
患者平均年龄为 73.2（SD 11.7）岁。在 823 名患者中，536 名（65.1%）为女性，660 名（80.2%）为城市居民。在接受依从性提醒电话之前，依从性队列（475/823，57.7%）的平均传输率为 74.9%，之后为 91.3%，而非依从性队列（348/823，42.3%）的平均传输率分别为 39%和 58%。从第 1 个月到第 5 个月，依从性队列的传输率分别下降了 1.9%和 10.2%，而非依从性队列分别下降了 1.9%和 10.2%。在研究期间，依从性队列的收缩压和舒张压值分别平均改善了 2.2 和 0.7mmHg（P<.001 和 P=.004），而非依从性队列的收缩压值平均改善了 1.6mmHg（P=.02）。
尽管我们发现患者可以达到较高的依从性水平，但许多患者仍存在依从性问题。尽管依从性提醒电话有所帮助，但可能还不够。远程监测降低了血压，这与临床试验一致。此外，血压控制与依从性呈正相关。
