Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.
Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.
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DOI：
10.2196/46313
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发表时间：
2023-07-24
影响因子：
2.7
通讯作者：
Godino, Job Gideon
中科院分区：
文献类型：
--
作者：
Poblete, Jacqueline Yareli;Vawter, Natalie Lauren;Lewis, Sydney Virginia;Felisme, Earl Marc;Mohn, Paloma Adriana;Shea, Jennifer;Northrup, Adam William;Liu, Jie;Al-Rousan, Tala;Godino, Job Gideon
关键词：
根据循证临床指南，建议患有高血压的成年人每天两次自我监测血压（BP）。自测血压监测是改善高血压管理的推荐策略。我们的目的是确定基于数字的血压自我监测计划的可行性和可接受性，以促进低收入患者的高血压自我管理和健康教育。我们假设该计划高度可行和可接受，并且至少 50% 的患者会按照报销设备成本所需的费率使用监测仪（在任何 30 天内进行 16 天的测量）。 Withings BPM Connect 已部署给圣地亚哥家庭健康中心的患者。计划内容包括培训、短信提醒和医生沟通。计算依从性、使用情况、平均血压和血压控制状态。进行了 Kaplan-Meier 事件时间分析，以比较严格定义（在任何滚动 30 天窗口中≥16 天）和宽松定义（每周≥1 天，连续 4 周）之间的依从时间。进行对数秩检验以确定定义之间的合规时间差异是否具有统计显着性。计算干预前和干预后的平均收缩压（SBP）和舒张压（DBP）以及患者的SBP和DBP平均变化。进行配对样本 t 检验（2 尾）以评估干预前后收缩压和舒张压的变化。共有 179 名患者接受了监测仪。干预前后 SBP 和 DBP 的平均变化分别为 +2.62 (SE 1.26) mm Hg 和 +3.31 (SE 0.71) mm Hg。与干预前相比，干预后 SBP 和 DBP 均出现统计学显着升高（P=.04 和 P<.001）。在第一次和最后一次测量时，分别有 37.5% (63/168) 和 48.8% (82/168) 的患者血压得到控制。在观察期间，83.3% (140/168) 的患者至少进行过 1 次受控血压测量。随着时间的推移，使用情况逐渐减少，53.6% (90/168) 的患者在第 2 周使用监测仪，而在第 11 周只有 25% (42/168) 的患者使用监测仪。虽然只有 25.6% (43/168) 达到了严格的依从性定义，但 42.3% (71/168) 的患者达到了宽松的依从性定义。严格定义的中位合规时间为 130 天，宽松定义的中位合规时间为 95 天。对数秩检验显示，合规定义之间的合规时间存在统计显着差异 (P<.001)。只有 26.8% (45/168) 遵守了导致设备成本报销的测量率。很少有患者使用监护仪的速度能够得到报销，这引发了财务可行性的担忧。需要进一步评估低收入患者维持费用的计划。
According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device’s cost (16 days of measurements in any 30-day period). Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.
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影响因子：
5.5
作者：
Farley, Thomas A.;Dalal, Mehul A.;Frieden, Thomas R.
通讯作者：
Frieden, Thomas R.
DOI：
10.1111/jch.13141
发表时间：
2018-01
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Hanlin RB;Asif IM;Wozniak G;Sutherland SE;Shah B;Yang J;Davis RA;Bryan ST;Rakotz M;Egan BM
通讯作者：
Egan BM
影响因子：
5.4
作者：
Kirkland EB;Heincelman M;Bishu KG;Schumann SO;Schreiner A;Axon RN;Mauldin PD;Moran WP
通讯作者：
Moran WP
影响因子：
44.5
作者：
Godino, Job G.;Merchant, Gina;Norman, Gregory J.;Donohue, Michael C.;Marshall, Simon J.;Fowler, James H.;Calfas, Karen J.;Huang, Jeannie S.;Rock, Cheryl L.;Griswold, William G.;Gupta, Anjali;Raab, Fredric;Fogg, B. J.;Robinson, Thomas N.;Patrick, Kevin
通讯作者：
Patrick, Kevin
影响因子：
5.5
作者：
Gross GN
通讯作者：
Gross GN