Home based telemedicine intervention for patients with uncontrolled hypertension--a real life non-randomized study.
Home based telemedicine intervention for patients with uncontrolled hypertension--a real life non-randomized study.
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DOI：
10.1186/1472-6947-14-52
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发表时间：
2014-06-12
影响因子：
3.5
通讯作者：
Muiesan ML
中科院分区：
文献类型：
--
作者：
Bernocchi P;Scalvini S;Bertacchini F;Rivadossi F;Muiesan ML
尽管有几类耐受性良好且有效的降压药，但对血压的控制往往是不够的。造成这一现象的原因可能有几个因素，包括使用低于最佳剂量的药物、治疗不充分或无效以及服药依从性差。目前非随机研究的目的是评估以家庭为基础的远程医疗服务在未控制的高血压患者中的有效性。74名患者参加了以家庭为基础的远程医疗组，94名患者参加了普通护理组。在基线和研究结束时，两组患者都在心脏病科办公室就诊。家庭远程医疗组的患者另外由一名医生-护士通过计划和非计划的电话预约进行随访。这些患者还接受了血压测量设备，该设备可以通过安全的数据连接将读数传输到中央数据监视器。在研究期间(80 ± 25天)，家庭远程医疗组总共进行了17401次血压测量，对应于每个患者的236 ± 136读数，平均每天测量3 ± 1.7。计划电话接触(护士发起)为5.2 ± 4.3/患者(共370次)，非计划电话接触(患者发起)为0.4 ± 0.9/患者(共30次)。研究结束时，平均收缩压值从153.00 ± 19 降至130.00± 15 mm Hg(p <； 0.0001)，舒张压从89 ± 10 降至76 11 mm Hg(p <； 0.0001)。在常规护理组，研究结束时，平均收缩压值从15 6 ± 16 mm Hg降至14 9 ± 17 mm Hg(p <； 0.05)，舒张压从90 ± 8 mm Hg降至86 ± 9 mm Hg(p <； 0.05)。电话接触后开始药物治疗的变化为1.81 ± 1.73/例。在远程血压远程监测的支持下，增加结构化的医生-护士方法可能会改善无法控制的高血压患者的预后。
Control of blood pressure is frequently inadequate in spite of availability of several classes of well tolerated and effective antihypertensive drugs. Several factors, including the use of suboptimal doses of drugs, inadequate or ineffective treatments and poor drug compliance may be the reason for this phenomenon. The aim of the current non- randomized study was to evaluate the effectiveness of a Home-Based Telemedicine service in patients with uncontrolled hypertension. 74 patients were enrolled in a Home Based Telemedicine group and 94 patients in the Usual Care group. At baseline and at the end of the study, patients in both groups were seen in a cardiology office. Patients in Home Based Telemedicine group additionally were followed by a physician-nurse, through scheduled and unscheduled telephone appointments. These patients also received a blood pressure measuring device that could transmit the readings to a central data monitor via secure data connection. During the study period (80 ± 25 days), a total of 17401 blood pressure measurements were taken in the Home Based Telemedicine group corresponding to 236 ± 136 readings per patient and a mean daily measurement of 3 ± 1.7. The scheduled telephone contacts (initiated by the nurse) equaled to 5.2 ± 4.3/patient (370 in total) and the unscheduled telephone contacts (initiated by the patients) were 0.4 ± 0.9/patient (30 in total). The mean systolic blood pressure values decreased from 153 ± 19 mmHg to 130 ± 15 mmHg (p < 0.0001) at the end of the study and diastolic blood pressure values decreased from 89 ± 10 mmHg to 76 ± 11 mmHg (p < 0.0001). In the Usual Care group, the mean systolic blood pressure values decreased from 156 ± 16 mmHg to 149 ± 17 mmHg (p < 0.05) at the end of the study and diastolic blood pressure values decreased from 90 ± 8 mmHg to 86 ± 9 mmHg (p < 0.05). The changes in drug therapy initiated following telephone contacts were 1.81 ± 1.73 per patient. The addition of a structured physician-nurse approach supported by remote telemonitoring of blood pressure is likely to improve outcome in patients with uncontrolled hypertension.