A national mHealth project targets hypertension

From the mHealthNews archive
By Jerry Penso

With more the 53 percent of U.S. adults owning a smartphone and more than 30 percent of smartphone owners reporting use of the mobile device to look for health advice, it is clear that consumers want easily accessible information to better manage their health. In fact, a recent poll shows nearly half of American adults are extremely or very interested in being able to check their own blood pressure on smartphones or tablets.

As consumers seek more opportunities to be involved in, and have some control over, their entire medical picture, new technology needs to make data both available and actionable. The advent of new mobile technology is promising for the healthcare industry – enabling providers to not only send information to patients but also to receive information that leads to better care. The ongoing challenge, however, is identifying the right technology to make sure health information is provided in the right format, at the right time, in the right place and to the right person.

The American Medical Group Foundation’s (AMGF) Measure Up/Pressure Down hypertension campaign is at the forefront of meeting that challenge. The AMGF recently launched a pilot project to encourage the use and adoption of wireless home blood pressure monitors by mid- and large-sized medical groups and health systems. The project supports the campaign’s goal of 80 percent hypertension control rates for patients at more than 140 member organizations by the end of 2015. 

Across the nation, 150 patients diagnosed with pre-hypertension or hypertension are using the Withings Wireless Blood Pressure Monitor, the Health Mate mobile application and their smartphones or tablets to measure their blood pressure and automatically send the readings to a data portal accessed by members of their care team. From there, care teams at four medical groups - Billings Clinic, Community Physician Network, Cornerstone Health Care, P.A., and Wilmington Health – regularly review home blood pressure readings and then facilitate appropriate follow-up visits, medication titration and lifestyle changes as needed.

While programs of this type are designed to better engage the patients, each individual medical group has leveraged unique tactics to recruit and onboard those patients in most need of intervention or assistance. Cornerstone Health Care relied on providers to identify patients with high blood pressure and then conducted device trainings in the clinic. Through these efforts, the North Carolina medical group was able to enroll 37 patients in a two-week period. Across the state, Wilmington Health recruited its own employees to participate, and at Billings Clinic in Montana the mobile blood pressure monitors are used to engage patients located in surrounding rural communities – often hundreds of miles from their provider.

After patients were properly leveraging the mobile solution, each organization was tasked with identifying best practices for monitoring and implementing care changes. Indianapolis-based Community Physician Network, for instance, relies on a clinical pharmacist to:

  • Review readings;
  • Add or discontinue medications on behalf of a provider and within the parameters of a collaborative agreement and physician-approved protocols to expedite control; or
  • Schedule a follow-up appointment for in-office blood pressure measurement and lifestyle coaching.

Meanwhile, at Wilmington Health, a quality department leader and health coach access the readings on a daily basis. Any elevated readings are flagged and immediately brought to the provider’s attention.

Wilmington Health saw the benefits from project participation in just a few weeks. In one instance, a 35-year-old patient scheduled an appointment with his primary care provider after feeling ill. At his visit, his lethargy and headaches combined with multiple high blood pressure readings led his provider to prescribe him a home blood pressure monitor as part of the pilot project. Within a week of regular readings, he was diagnosed with hypertension and prescribed medication. The patient credits the project to preventing a stroke and saving his life.

Pilot project analysis, scheduled for June completion, will go beyond anecdotal accounts of improvement to include patient and provider satisfaction surveys, in-depth interviews and a sophisticated analysis of individual patients, focusing on issues such as blood pressure improvement, patterns of device use, the ability to compare accuracy of readings on the device with those in the office, and treatment patterns.

In the meantime, health organizations interested in developing mHealth or other technology-enabled programs that engage patients in better control of their hypertension should consider the following best practices:

  • Ensure all direct care team members are trained in accurate blood pressure measurement and all team members understand the importance of blood pressure metrics and goals;
  • Adopt clinical guidelines and best practices that incorporate the use of multiple types of patient education and support to promote lifestyle behavior changes that sustain hypertension control;
  • Identify hypertensive patients who are most likely to use mobile technology and who are motivated to make changes that positively affect their health;
  • Evaluate a variety of technologies, such as wireless blood pressure cuffs, and mobile applications that enable communication between provider and patient, and select technology that is easy to use in a patient’s everyday routine;
  • Create a process to receive data, evaluate information and initiate interventions and follow up with patients; and
  • Monitor results and re-evaluate program on a regular basis for opportunities to improve.

Although hypertension is one of the most important risk factors for heart disease, stroke, kidney failure and diabetes complications, it is an ongoing challenge to diagnose and manage because it does not have overt symptoms. For this reason, patients may not adhere to recommended medication or lifestyle regimens. Providers should consider offering mobile health tools that provide patients with immediate feedback to demonstrate how lifestyle changes or adherence to medication therapies improve blood pressure.

Incorporating these tools into a practice helps create a higher level of patient awareness and engagement. The consistent flow of information also enables providers to intervene earlier when issues arise and to support patients’ efforts to manage their health.

Jerry Penso, MD, MBA, is chief medical and quality officer of the American Medical Group Association.