HOME BLOOD-PRESSURE MONITORING - EFFECT ON USE OF MEDICAL-SERVICES AND MEDICAL-CARE COSTS
HOME BLOOD-PRESSURE MONITORING - EFFECT ON USE OF MEDICAL-SERVICES AND MEDICAL-CARE COSTS
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DOI：
10.1097/00005650-199209000-00009
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发表时间：
1992-09-01
期刊：
影响因子：
3
通讯作者：
VOGT, TM
中科院分区：
文献类型：
--
作者：
SOGHIKIAN, K;CASPER, SM;VOGT, TM
本研究的目的是确定患者在家中监测自己的血压（BP）的高血压管理计划是否可以在不影响血压控制的情况下降低成本。这项前瞻性、随机、对照的1年临床试验在旧金山弗朗西斯科湾地区Kaiser Permanente医疗护理计划的4个医疗中心进行。在467例由医生转诊的无并发症高血压患者中，37例拒绝参加研究; 215例被随机分配到家庭护理（UC）组，215例被随机分配到家庭BP组。25例UC患者和15例家庭BP患者未返回进行年终BP测量。UC组的患者被转介回他们的医生。家庭血压组的患者接受了测量自己血压的培训，并通过邮件返回读数。患者在家中血压异常高或低的情况下，需要遵循标准程序。使用的门诊医疗服务的数量和类型从研究年度和前一年的患者病历中获得。高血压的护理成本通过分配给每个门诊服务的相对价值单位来计算。经过培训的技术人员在进入研究时和1年后测量每例患者的BP。在研究年内，家庭BP患者的高血压相关办公室访视比UC患者少1.2次（95%置信区间（CI：0.8，1.7））。家庭BP组中与高血压治疗相关的医生访视、电话和实验室检查的平均调整成本为每例患者每年88.76美元，比UC组低29%（95% CI：16.11美元，54.74美元）。实施家庭BP系统的年化成本在研究年期间约为每例患者28美元，目前约为15美元。1年后，家庭BP组男性的血压控制优于UC组男性;两组女性的血压控制同样良好。基于定期家庭血压报告的无并发症高血压管理可以实现血压控制，减少医生就诊，从而节省大量费用。
The objective of this study was to determine whether a hypertension management program in which patients monitor their own blood pressure (BP) at home can reduce costs without compromising BP control. The prospective, randomized, controlled 1-year clinical trial was conducted at four medical centers of the Kaiser Permanente Medical Care Program in the San Francisco Bay Area. Of 467 patients with uncomplicated hypertension who were referred by their physicians, 37 declined to participate in the study; 215 were randomly assigned to a Usual Care (UC) group and 215 to a Home BP group. Twenty-five UC patients and 15 Home BP patients did not return for year-end BP measurements. Patients in the UC group were referred back to their physicians. Patients in the Home BP group were trained to measure their own BP and return the readings by mail. Patients were given a standard procedure to follow in case of unusually high or low BP readings at home. The number and type of outpatient medical services used were obtained from patient medical records for the study year and the prior year. Costs of care for hypertension were calculated by assigning relative value units to each outpatient service. Trained technicians measured each patient's BP at entry into the study and 1 year later. Home BP patients made 1.2 fewer hypertension-related office visits than UC patients during the study year (95% confidence interval (CI: 0.8, 1.7). Mean adjusted cost for physician visits, telephone calls, and laboratory tests associated with hypertension care was $88.76 per patient per year in the Home BP group, 29% less than in the UC group (95% CI: $16.11, $54.74). The annualized cost of implementing the home BP system was approximately $28 per patient during the study year and would currently be approximately $15. After 1 year, BP control in men in the Home BP group was better than in men in the UC group; BP control was equally good in women in both groups. Management of uncomplicated hypertension based on periodic home BP reports can achieve BP control with fewer physician visits, resulting in substantial cost savings.