The George Washington University, Washington, DC, USA.
Virginia Commonwealth University, Richmond, VA, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231204586. doi: 10.1177/21501319231204586.
In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population.
In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs.
A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, = .135). Financially, the program generated margins of $29 per patient at 90 days.
Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.
在美国，有 48%的成年人患有高血压，每年的直接医疗费用超过 1300 亿美元。远程患者监测（RPM）已被讨论为治疗高血压的有用工具，但很少有研究评估其在少数民族和较低社会经济地位（SES）人群中的成本效益或疗效。我们的研究旨在评估 RPM 在以少数民族和低 SES 人群为主的高血压管理中的临床和财务结果。
在这项前瞻性队列研究中，从一家学术附属的初级保健诊所中随机选择未经控制的原发性高血压患者（通过联合国家委员会 8 指南定义）。患者按滚动方式入组 90 天。患者被要求每天传输血压读数。研究助理每周都会给患者打电话，如果有问题会将问题升级给初级保健医生。对照组是同一诊所人群中未经治疗的 299 名高血压患者，在干预研究结束时通过回顾性图表记录进行分析。主要结局是血压控制。次要结局是收缩压的相对改善和直接成本。
共有 13 名患者被纳入 RPM 干预组；这些患者中 54%为女性，100%为非裔美国人，77%为医疗补助。通过意向治疗分析评估时，干预组患者在 90 天时的血压控制非劣效（46%的实验组 vs 31%的对照组， = .33），90 天时的收缩压平均变化（13.5 vs 3.7mmHg， = .174），同时在 90 天时门诊就诊次数显著减少（1.5 次 vs 5.9 次， < .001）与对照组相比。基于方案的分析结果也显示了非劣效的血压控制（63% vs 31%， = .135）。从财务角度来看，该计划在 90 天时为每位患者带来了 29 美元的利润。
与 90 天时的回顾性对照组相比，我们的少数民族和医疗补助为主的队列中的患者在 90 天时实现了非劣效的血压控制，并且所有原因的就诊次数在 90 天时显著减少。该计划每位患者的收入很少，实施的主要障碍包括患者的依从性和支付方的拒绝。
