Telemonitoring in Rural Elder Nutrition Centers: Demonstration Project of Hypertension Management

This project, the Technologies for Enhancing Access to health Management (TEAhM) project, was a pilot study which implemented and evaluated telehealth kiosks in community-based senior centers. The project team was composed of a partnership between researchers from LeadingAge, Wright State University, Healthanywhere, and four senior centers in rural Ohio. Comparisons were made between seniors with hypertension who  used the kiosk over ten months, and those hypertensive seniors who did not. Two of the senior centers served as intervention sites, while the other two served as controls. A total of 113 seniors were enrolled in the project, 41 of whom used the kiosk. The main objectives of the project were to:

• Determine proof-of-concept for a system in which telehealth monitors can be utilized to manage blood pressure in a community setting that targets high risk elders.
• Compare blood pressure control in a telehealth group to blood pressure control in a control (non-telehealth) group.

Blood pressure data from the kiosks was transmitted to a central server monitored by study nurses.  Data was entered into an electronic health record with an alert system: nurses were alerted by e-mail if study patients' blood pressures reached a certain threshold as defined by the patient's primary care physician.

The project was effective at creating alerts in response to elevated blood pressure so that those results could be managed immediately.  The team found it challenging to connect with the seniors’ primary care physicians to obtain blood pressure referral protocols and felt that overcoming this challenge in the future would be important to ensure success of this type of project. Of note, a post-study physician survey revealed that while physicians see the value in this type of service, many of the physicians were unaware that they had patients involved in the study. 

The directors at the two senior centers with the kiosks felt that study participants valued the kiosks and thought that the use of the technology itself was easier than it had been expected to be.  They also felt that the use of telehealth services at senior centers was a natural extension of existing programming in their communities.  Staff reported that they saw clear value in the program, and felt that senior centers were a good venue for this technology. 

Study participants noted value in the kiosks, but expressed frustration over the number of follow-up calls they received in response to the study nurses receiving blood pressure alerts.  The vast majority of participants, 95 percent, reported that they were "very comfortable" with the use of the kiosk. 

The project was able to show that this type of technology is well accepted by both seniors and senior center staff.  Further study could more directly involve primary care practices, building on TEAhM.  Such a project could help to improve connections between community-based senior centers routinely used by seniors and the physicians that care for them.