If 45 percent of patients with hypertension are already measuring blood pressure at home, and an increasing number of patients now have access to communication with their doctors via a secure patient portal, does it make sense for patients to be reporting their blood pressure numbers via the portal? This is the question the Mayo Clinic set out to answer in a study published this month in the journal Telemedicine and eHealth.
The Mayo Clinic looked at 52,373 secure messages in their patient portal and picked out the 624 that contained reports about home blood pressure monitoring, from qualitative assessments like "my BP was a little high" to quantitative reports of actual blood pressure measurements.
Ninety-nine percent of the messages elicited replies, either from the doctor or another member of the care team. Fifty-five percent of respondents were physicians, 31 percent were nurses, and 7 percent were physician's assistants or nurse practitioners. In the discussion section, study authors talked a little more about the message content.
"Patient concerns about high and low BP accounted for over one-third of the messages," they wrote. "There were concerns about BP medication side effect in about 10 percent, and dosage changes were mentioned in 13 percent of the patient messages. In essence, about 50 percent of the messages involved BP medication management. Despite the medical concerns voiced by patients in their secure messages, there was little evidence that patients were using messages to gain face-to-face access. We only found a patient request for an appointment in 3 percent of the messages, and providers suggested an appointment in only 11 percent of the message responses. These findings suggest that BP information transmitted asynchronously via the portal was acceptable both for patients and providers as a means for BP management without a face-to-face visit."
But while patients and doctors found the portal useful and acceptable for discussion, patients didn't really transmit useful information. When doctors were asked to express their confidence level in prescribing based on the information contained in the messages, they expressed a moderate or extreme level of confidence only 12 percent of the time. Assessed in accordance with AHA guidelines, only 7 percent of messages would be considered to have enough information for clinical decision-making.
However, Mayo Clinic thinks that over time, the patient portal will find its place in blood pressure management, alongside more reliable but expensive methods like real-time telemonitoring.
"Secure messages for BP management need to be examined in the context of an overall telemedicine strategy for BP management," they wrote. "We know that real-time BP telemonitoring can successfully be used for BP management, but at $500 for 12 months it can be quite expensive. Although virtual visits (e-visits) are being used for BP management, they have not been well studied, and we do not know the best type of information management needed for these types of asynchronous visits. Secure messages may fit into a niche alongside dedicated telemonitoring (with hubs and servers) and e-visits. Patients with adequate control of their BP and no concerns about their antihypertensive medication could use a secure message to confirm adequate BP control without requiring an office visit. Patients needing frequent BP measurements or titration of antihypertensive medications would need more robust data-capturing support from dedicated telemonitoring systems or e-visits."