Department of Neurology, USCF Medical Center, San Francisco, CA, United States of America.
Department of Neurology, Stanford Hospital and Clinics, Palo Alto, CA, United States of America.
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108073. doi: 10.1016/j.jstrokecerebrovasdis.2024.108073. Epub 2024 Oct 10.
Despite strong evidence for maintaining blood pressure (BP) < 130/80 for secondary stroke prevention, there have been many barriers toward achieving this goal. The purpose of this pilot study was to assess the feasibility of a new physician-led BP telemedicine program on the improvement of BP and medication compliance in stroke survivors.
We prospectively enrolled patients with a history of stroke and hypertension into this BP telemedicine program where participants were paired with a physician for one-on-one counseling. Participants submitted daily recordings of their BP as well as completed surveys assessing the usability of the program (Marshfield Usability Survey) and medication compliance (Morisky Medication Adherence Scale). A repeated measures ANOVA was utilized to examine differences in BP recordings at enrollment, 3 months, and 6 months.
Due to an interruption of external funding only 27 patients were ultimately enrolled (4/25/22-10/15/23). There were significant differences over time for both systolic (p = 0.022) and diastolic (p = 0.007) BP, however these differences were seen only between the enrollment and 6-month timepoint in follow-up testing. Participants rated the program highly favorably across multiple categories, commenting on the ease of using the program and feeling confident in the system. There was also an observed reduction in reported barriers to taking medications.
This pilot program demonstrated the feasibility of managing BP using a telemedicine approach. A minimum of 6 months was required to see significant differences in BP as well as trends toward improvements in medication compliance. These results have an impact in how similar remote programs should be designed for future evaluations of this patient population.
尽管有强有力的证据表明将血压（BP）维持在<130/80mmHg 有助于二级预防中风，但在实现这一目标方面存在许多障碍。本研究旨在评估一种新的以医生为主导的血压远程医疗计划在改善中风幸存者血压和药物依从性方面的可行性。
我们前瞻性地招募了有中风和高血压病史的患者参加该血压远程医疗计划，其中参与者与一名医生进行一对一咨询。参与者每天提交血压记录，并完成评估该计划可用性的调查（马什菲尔德可用性调查）和药物依从性（Morisky 药物依从性量表）。采用重复测量方差分析来检查入组时、3 个月和 6 个月时的血压记录差异。
由于外部资金中断，最终只有 27 名患者入组（4/25/22-10/15/23）。收缩压（p=0.022）和舒张压（p=0.007）均随时间出现显著差异，但这些差异仅在随访测试中观察到入组时和 6 个月时之间。参与者对多个类别给予了高度好评，评论了使用该计划的便利性，并对系统充满信心。报告的药物服用障碍也有所减少。
该试点计划证明了使用远程医疗方法管理血压的可行性。至少需要 6 个月才能观察到血压的显著差异以及药物依从性改善的趋势。这些结果对未来针对该患者群体的类似远程计划的设计方式具有影响。
