Price-Haywood Eboni G, Olet Susan, Singh Savita D, Burton Jeffrey
Ochsner Xavier Institute for Health Equity and Research, 1401 A Jefferson Highway, New Orleans, LA, 70121, USA.
Center for Outcomes Research, 1401 A Jefferson Highway, New Orleans, LA, 70121, USA.
J Gen Intern Med. 2025 Sep 19. doi: 10.1007/s11606-025-09823-w.
Hypertension is a major driver of healthcare costs. Remote physiologic monitoring (RPM) combined with team-based chronic disease care management can improve blood pressure (BP) control and reduce risk of high-cost cardiovascular events.
To examine whether a pharmacist-led Digital Medicine program improves BP control, medication adherence, healthcare utilization, and cost of care among racial subpopulations of Medicare patients.
Retrospective single-institution observational study conducted between January 1, 2019, and October 15, 2023.
Medicare patients with hypertension enrolled in the intervention with ≥ 3 office-based BP readings within 6-month periods pre- and post-index event and their propensity score-matched controls.
Remote pharmacist-physician collaborative care employing RPM with lifestyle, medication, and care gap management.
Primary outcome was BP control (office-based). Secondary outcomes were medication adherence, service utilization, and cost of care. Outcomes were assessed at baseline, 3, 6, 12, and 18 months using difference-in-difference (DID) approach stratified by race.
A total of 5057 patients were included in the analysis. At baseline, Black patients had lower proportions of BP control. By 18 months, intervention compared to controls had higher rates of BP control (Digital-Medicine vs control, Proportion [95%CI]: Black, 0.761[0.728, 0.795] vs. 0.687 [0.654, 0.721]; White, 0.777 [0.755, 0.799] vs. 0.727 [0.704, 0.750]) and greater reductions in average SBP (DID, mmHg [95%CI]: Black, - 1.74 [- 3.18, - 0.29]; White, - 3.22 [- 4.22, - 2.23]) across racial subgroups. Differences in average DBP reductions were only significant for White patients (DID: Black, - 0.45 [- 1.23, 0.32]; White, - 1.48 [- 2.02, - 0.95]). Intervention compared to controls had higher odds of medication adherence, lower rates of inpatient and emergency department utilization, and no significant changes in primary care visits. Minimal changes in cost were observed.
Remote pharmacist-led care management increased BP control across racial subpopulations and improved medication adherence and acute care service utilization.
高血压是医疗成本的主要驱动因素。远程生理监测（RPM）与基于团队的慢性病护理管理相结合，可以改善血压（BP）控制并降低高成本心血管事件的风险。
研究由药剂师主导的数字医学项目是否能改善医疗保险患者种族亚群体的血压控制、药物依从性、医疗服务利用情况及护理成本。
2019年1月1日至2023年10月15日进行的回顾性单机构观察性研究。
纳入干预措施的患有高血压的医疗保险患者，在索引事件前后6个月内有≥3次基于诊室的血压读数，以及倾向得分匹配的对照组。
采用远程药剂师-医生协作护理，结合RPM进行生活方式、药物和护理差距管理。
主要结局是血压控制（基于诊室）。次要结局是药物依从性、服务利用情况和护理成本。使用按种族分层的差异-in-差异（DID）方法在基线、3个月、6个月、12个月和18个月时评估结局。
共有5057名患者纳入分析。在基线时，黑人患者的血压控制比例较低。到18个月时，与对照组相比，干预组的血压控制率更高（数字医学组与对照组，比例[95%置信区间]：黑人，0.761[0.728, 0.795]对0.687[0.654, 0.721]；白人，0.777[0.755, 0.799]对0.727[0.704, 0.750]），并且各种族亚组的平均收缩压降低幅度更大（DID，mmHg[95%置信区间]：黑人，-1.74[-3.18, -0.29]；白人, -3.22[-4.22, -2.23]）。舒张压平均降低幅度的差异仅在白人患者中显著（DID：黑人，-0.45[-1.23, 0.32]；白人，-1.48[-2.02, -0.95]）。与对照组相比，干预组的药物依从性几率更高，住院和急诊科利用率更低，初级保健就诊率无显著变化。观察到成本变化极小。
由远程药剂师主导的护理管理提高了各种族亚群体的血压控制水平，并改善了药物依从性和急性护理服务利用情况。
