Baratta Juliana, Brown-Johnson Cati, Safaeinili Nadia, Goldman Rosas Lisa, Palaniappan Latha, Winget Marcy, Mahoney Megan
Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States.
JMIR Form Res. 2022 Jun 10;6(6):e32874. doi: 10.2196/32874.
Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the US adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management.
From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program's acceptability, appropriateness, feasibility, and sustainability.
We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity.
A total of 63% (10/16) of the patients and 40% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time.
Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs.
高血压是心血管疾病最普遍且最重要的危险因素，影响着近50%的美国成年人口；然而，这些患者中只有30%实现了血压控制。将考虑个体患者需求的策略纳入初级保健，如远程血压监测，可能会改善高血压管理。
2018年3月至2018年12月，斯坦福大学实施了一项名为“全人类”的精准健康试点项目，旨在利用高科技和高接触式医疗为高血压等疾病提供个性化护理。我们研究了多方利益相关者对“全人类”项目中高血压管理的看法，以评估该项目的可接受性、适宜性、可行性和可持续性。
我们对16名患者和15名健康专业人员进行了半结构化访谈，以评估他们在“全人类”项目中进行高血压管理的经历。我们采用归纳和演绎分析相结合的方法对访谈进行转录和分析，以确定围绕高血压管理的共同主题，并采用共识方法确保可靠性和有效性。
共有63%（10/16）的患者和40%（6/15）的健康专业人员在“全人类”项目的背景下提到了高血压。这些参与者报告说，远程血压监测提高了积极性、血压控制和整体诊所效率。健康专业人员讨论了可行性挑战，包括分析血压数据和提供个性化反馈所需的时间、血压数据的整合、血压袖带的技术难题，以及随着时间推移患者对远程血压监测的使用减少。
“全人类”项目中用于高血压管理的远程血压监测对患者和健康专业人员来说是可接受的，且适合护理。需要通过利用团队式护理、促使患者持续进行远程血压监测、规范血压测量的电子病历整合以及寻找更用户友好的血压袖带，来解决重要挑战，以提高这种方法的可行性和可持续性。
