Ideas That Work

Patients managing their own care works. Support groups work. Telemedicine combined with self-administered home care works. At least sometimes. Bill Gardner reports on two new studies, including this one.

Margolis and her colleagues tested a program for hypertension. Patients measured their blood pressure at home and logged it using internet-mediated telemetry. The patients then received coaching based on the data.

During the first 6 months of the intervention, patients and pharmacists met every 2 weeks via telephone until BP control was sustained for 6 weeks, and then frequency was reduced to monthly. During intervention months 7 through 12, telephone visits occurred every 2 months. After 12 months, patients discontinued use of the telemonitors, returned to the care of their primary physicians, and no longer received support from a study pharmacist.

The telemonitored and coached patients lowered blood pressure significantly more than patients in usual care, including up to 6 months after the monitors were discontinued.

Comments (12)

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  1. Cabaret says:

    That’s great! Actual results!

    • Bolton says:

      Yea, but who is going to pay for the service? Do you think the benefit is great enough for insurance companies to implement it? If not them, who else?

      • Tally says:

        Good questions. I think patients need to exercise preventative care and this may help in terms of blood pressure-related disease, but it may be costly at first and then only may go down in price to justify its use if the demand is high enough and insurance companies allow for competition.

      • Jeff says:

        I think it is great enough for insurance companies to implement it, because insurance companies would have to do less and hospitals would have to do less. The only question that remains is it cost effective, there would have to be more analysis on that for there to be a fair conclusion on whether or not it would be legitimately adopted by insurance agencies.

    • Carla says:

      There typically are results to studies…i’m not exactly sure what the difference between results and actual results are, but yes, astute analysis.

  2. Salvador says:

    As with many ideas, there are pros and cons. This seems promising, but we also must be aware of potential consequences. Cost, negligence, etc.

    • Tomas says:

      Right, but the results from the study show most of the benefits.

    • Jeff says:

      Cost. On it’s face it seems like it would be cheaper than a hospital visit, but I guess that has yet to be proven empirically. Negligence. Well if you are negligent with your health you die, not to sound overly callus, but if you don’t care about your well-being it isn’t societies job to care for you.

  3. Devon Herrick says:

    Patient are a paradox. On the one hand, 80% of medical care (at least initially) is self-care. But, once we step foot in the doctor’s office, many of us abdicate all responsibility.

    I think motivated patients — with the appropriate incentives — can do a great job of managing their own here using telemedicine and online coaching. The key it to give patients the appropriate incentives.

  4. Linda Gorman says:

    Not sure that this is an idea that “works.” Am unable to determine whether 7 mm difference is worth $1,350 a year for care management and telecommunications equipment.

    They had 14,692 patients eligible for selection into this study (two high blood pressure readings in primary care visits). 12,672 were excluded due to no response to an invitation, not interested, or unable to reach.

    Out of the 2020 they ended up assessing for eligibility, 442 refused to participate, they were unable to reach 152, and 56 didn’t show up for assessment. 920 didn’t meet the criteria for assessment. Of those, 652 didn’t have high blood pressure and 126 didn’t have a landline phone.

    Draw your own conclusions about how randomized the sample drawn for randomization was.

    Only 82 percent of both groups attended the final follow-up assessment.

    At 18 months, mean systolic was 126.9 (down 21.3 from baseline) for intervention group and 133.0 for usual care group (down 14.7 from baseline). Mean diastolic was 75.1 (down 9.3) for intervention group, 78.8 (down 6.4) for intervention group. Intervention group took more meds.