Logan A et al. 2007 "Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients."
Reference
Logan AG, McIsaac WJ, Tisler A, et al. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Am J Hypertens 2007;20(9):942-948.
Abstract
"BACKGROUND: Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care. METHODS: Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system's development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements. RESULTS: The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians' reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (+/-13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective. CONCLUSIONS: The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension."
Objective
"To develop and pilot-test a home BP tele-management system that actively engages patients in the process of care."
Tools Used
Type Clinic
Primary care
Size
unknown
Type of Health IT
Telemedicine
Electronic medical records (EMR)
Type of Health IT Functions
Health functions include mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Blood pressure (BP) is measured with a Bluetooth-enabled BP monitor and a dedicated, programmed mobile phone. The data are automatically transmitted when the telephone is being charged to a Web-based server.
Workflow-Related Findings
In this pilot study, BP fell significantly and BP control improved significantly.
"One concern of physicians involved an increase in their workload, particularly if dozens of their patients started using the system. To avoid the transmission of unsolicited BP reports, they were generated and faxed to the doctor's office only on request of the patient or the physician's office staff before or at the time of the scheduled patient visit. Critical BP alerts were sent automatically to the physician's office."
"Patients were enthusiastic about the self-care aspects of the proposed system, were confident in their ability to use it, and were comfortable using a mobile phone. They were less familiar with a personal digital assistant (PDA). Surprisingly, there was little concern about the security of the proposed electronic transmission of personal medical data."
"Physicians were skeptical that patients would measure their BP regularly
and feared that self-measurements would needlessly induce anxiety. Their most serious concerns were legal liability and disruption of workflow. There was concern that they would be accountable to address unsolicited BP alerts in a timely fashion. As well, they would not be compensated for their work related to addressing alerts" and reports, because this work was not tied to a face-to face patient visit.
and feared that self-measurements would needlessly induce anxiety. Their most serious concerns were legal liability and disruption of workflow. There was concern that they would be accountable to address unsolicited BP alerts in a timely fashion. As well, they would not be compensated for their work related to addressing alerts" and reports, because this work was not tied to a face-to face patient visit.
"17 of 20 patients indicated that they would like to continue using the system or use it in the future. Of the remainder, one patient was unsure, and two did not endorse the system."
Eighteen out of 20 patients believed that the BP reports helped them and their doctor decide how best to treat their BP.
Study Design
Pre-postintervention (no control group)
Study Participants
Study participants for phase one included 24 hypertensive type 2 diabetic patients and 18 family physicians that were interviewed in one of four group sessions. For phase two, participants included 33 type 2 diabetic patients with uncontrolled ambulatory BP recruited from the practices of 25 family physicians.