Virtual, in-person visits lead to similar blood pressure control for hypertension patients

By Dave Muoio
04:13 pm

A recent study of hypertension patients suggests follow-up visits conducted virtually are just as effective in maintaining blood pressure control as those conducted in person.

Conducted by researchers at the Massachusetts General Hospital (MGH) and Brigham and Women’s (B&W) Hospital, the investigation also found no differences in non-primary care visits between the two patient groups.

"The use of virtual visits to reduce in-person office utilization without negative effects on blood pressure control or the need for other services could significantly expand access for patients of busy primary care practices,” Dr. Michael Levine, a clinician and investigator at B&W and Harvard Medical School, and the study’s lead author, said in a statement. “Many groups, especially insurance companies, have been skeptical of virtual care because they believe it may increase the use of health care services, but our findings show that a virtual visit can substitute for, rather than add to, an in-person visit, decreasing overall health care utilization.”

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In the study, which was published in the Journal of General Internal Medicine, Levine and colleagues constructed a retrospective cohort of 1,783 MGH hypertension patients, half of whom participated in at least one virtual hypertension visit and half of whom were seen in person. These participants were matched by propensity scores, with both groups comprised of patients who were aged roughy 61 years, 44 percent female, 85 percent white, and had around five recorded chronic conditions.

Virtual visits included in the study were conducted between December 2012 and February 2016, and allowed patients to enter as many as five blood pressure readings per session, describe their medication-taking practices, report side effects, and ask questions. Primary care physicians reviewed these asynchronous sessions, and made adjustments in patients’ care accordingly.

Between these two groups, the researchers found no significant difference in adjusted systolic blood pressure improvements recorded six months after a participant’s initial office visit. Further, there were no significant differences after adjustments in the number of specialist visits, emergency department visits, or inpatient admissions; however, those who received at least one virtual session visited a primary care office 0.8 fewer times (95 percent confidence interval, 0.3 to 1.2).

"Our central finding was that you can use online, non-simultaneous communication to manage a chronic medical condition without office visits that can be inconvenient for patients and add to demands placed on busy primary care practices,” Dr. Ronald Dixon, a study coauthor and practitioner at MGH, said in a statement. "It also supports scaling this concept to other chronic diseases with the addition of devices allowing collection of needed patient information.”

Dixon also noted that a previous study in which he participated found that virtual visits such as these require physicians spend just a fifth of the time that an in-person visit would.

While trends seem to suggest that more patients are interested in virtual or telehealth visits as an alternative to primary care, some studies have noted that the technology could also inadvertently increase physicians’ obligations. Data suggesting that the technology could limit expenses have been mixed, with some studies finding cost savings and others the opposite.


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