Using a Telemedicine System to Promote Patient Care Among Underserved Individuals

Blood pressure (BP) control is important in cardiovascular disease prevention. Because many people have no symptoms from their hypertension they may not seek regular preventive care. There is more nonadherence to BP medications than some other medications because taking the medications does not make people feel differently if they are asymptomatic. Adherence to BP medications could be improved if patients were more engaged in their own treatment. To advance care for hypertension, the patient-provider relationship must become a partnership. Patient empowerment must be increased through education, self-management, collaborative goal setting, and treatment planning. Innovative strategies are needed to support the constructs of patient-centered care (PCC) in an efficient and cost-effective manner. The goal of this project was to evaluate a PCC approach to reduce BP in individuals with hypertension. Building on a pre-existing, internally developed telemedicine system, the research team created a patient-centered tool for managing hypertension within a primary care practice. The new system provided patient education on hypertension and served as a tool for self-management, shared decisionmaking, and treatment planning. The project incorporated hypertension treatment guidelines and quality measures, as well as automated reminders and feedback for both patients and health care providers. A cellular telephone interactive system accommodated subjects who did not have Internet access.

The specific aims of the project were to:

• Enhance the current telemedicine system by incorporating guideline-based algorithms for hypertension treatment as well as automated reminders and feedback for both patients and health care providers.
• Determine the percentage of patients meeting guidelines for anti-hypertensive medication therapy.
• Empower inner-city African American patients to take a more active role in their health care through self-monitoring, education, reinforcement, and feedback through telemedicine.
• Measure telemedicine utilization.
• Examine the impact of the telemedicine system on medical knowledge, self-efficacy, and the quality of doctor-patient interaction as compared to controls.
• Compare blood pressure outcomes between control and telemedicine groups after 6 months of telemedicine risk management.

The study was conducted over a 3-year period. Subjects were randomized to the telemedicine intervention or to the standard of care control arm. The majority of participants resided in federally designated underserved communities. A significant reduction in BP from baseline to the end of the study was noted in both groups, however no difference was observed between groups at followup. Nondiabetic subjects in the telemedicine group demonstrated a significant decrease in BP. Diabetic subjects showed similar reductions in systolic BP in the telemedicine and control groups. Adherence was similar for the two groups. Overall, the study demonstrated that telemedicine was a useful tool for managing hypertension among asymptomatic non-diabetic subjects.