Remote physiologic monitoring for hypertension in primary care: a prospective pragmatic pilot study in electronic health records using propensity score matching.
Remote physiologic monitoring for hypertension in primary care: a prospective pragmatic pilot study in electronic health records using propensity score matching.
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DOI：
10.1093/jamiaopen/ooac111
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发表时间：
2023-04
期刊：
影响因子：
2.1
通讯作者：
Persell SD
中科院分区：
文献类型：
--
作者：
Petito LC;Anthony L;Peprah YA;Lee JY;Li J;Sato H;Persell SD
自2019年以来，医疗保险和医疗补助服务中心根据高血压诊断和治疗指南涵盖了血压（BP）的远程生理监测（RPM）。在这里，我们将欧姆龙VitalSight RPM集成到卫生系统的电子健康记录中，无需手动输入即可传输血压和脉搏，评估可行性，并使用实用的前瞻性匹配队列研究来评估(1)非控制（最后两次血压≥140/90 mmHg）和(2)一般（诊断为高血压或最后一次血压≥140/90 mmHg）高血压患者人群的初始效果。17名临床医生在两个内科实践取向。符合条件的患者年龄为65-85岁，有医疗保险，前一年就诊≥1次。我们前瞻性地从卫生系统内的其他初级保健实践中确定匹配的对照（年龄、性别、血压和前一年的办公室就诊次数），并估计6个月后RPM可用性（临床水平）与患者血压结果之间的关系。ClinicalTrials.gov: NCT04604925。可行性。试点诊所的使用率很低：在6个月的试点期间，10名医生给118名患者开了RPM处方。这包括7%（14/207）的预先指定的未控制高血压队列和3.3%（78/2356）的一般高血压队列。接受调查的临床医生（n = 4）报告称，尽管他们建议有专门的注册护士或LPN来检查血压读数，但根据RPM BP，他们改变了患者的药物治疗。有效性。6个月时，飞行员训练组的血压控制率高于对照组（未控制组：31.4% vs 22.8%; P = 0.007；一般组：64.0% vs 59.7%; P < 0.001）。最后一次就诊时的收缩压无差异(mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P =。48)，而在普通人群中较低（131.8 [15.7]vs 132.8 [15.9]; P = .04）。两组患者抗高血压药物改变频率相似（非对照P = 0.986；常规P = 0.218）。尽管摄取，RPM可能改善了血压控制。一个潜在的机制是增加医生对不受控制的高血压的认识和关注。医生使用RPM的障碍需要进一步研究。
Since 2019, the Centers for Medicare and Medicaid Services covers remote physiologic monitoring (RPM) for blood pressure (BP) per hypertension diagnosis and treatment guidelines. Here, we integrated Omron VitalSight RPM into the health system’s electronic health record to transmit BP and pulse without manual entry, assessed feasibility, and used pragmatic prospective matched cohort studies to assess initial effects in (1) uncontrolled (last two office BP ≥140/90 mmHg) and (2) general (diagnosed hypertension or last office BP ≥140/90 mmHg) hypertension patient populations. Seventeen clinicians at two internal medicine practices were oriented. Eligible patients were aged 65–85 years had Medicare insurance with ≥1 office visit in the previous year. We prospectively identified matched controls (age, sex, BP, and number of office visits in previous year) from other primary care practices within the health system and estimated the association between RPM availability (clinic-level) and patient BP outcomes after 6 months. ClinicalTrials.gov: NCT04604925. Feasibility. Uptake was low at pilot clinics: 10 physicians prescribed RPM to 118 patients during the 6-month pilot. This included 7% (14/207) of the prespecified uncontrolled hypertension cohort and 3.3% (78/2356) of the general hypertension cohort. Surveyed clinicians (n = 4) reported changing their patients’ medical treatment in response to RPM BPs, although they recommended having a dedicated RN or LPN to review BP readings. Effectiveness. At 6 months, BP control was greater at pilot practices than among matched controls (uncontrolled: 31.4% vs 22.8%; P = .007; general: 64.0% vs 59.7%; P < .001). Systolic BP at last office visit did not differ (mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P = .48) in the uncontrolled population, and was lower in the general population (131.8 [15.7] vs 132.8 [15.9]; P = .04).The frequency of antihypertensive medication changes was similar in both groups (uncontrolled P = .986; general P = .218). Uptake notwithstanding, RPM may have improved BP control. A potential mechanism is increased physician awareness of and attention to uncontrolled hypertension. Barriers to RPM use among physicians require further study.
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影响因子：
120.7
作者：
Green, Beverly B.;Cook, Andrea J.;Thompson, Robert S.
通讯作者：
Thompson, Robert S.
影响因子：
5.4
作者：
Kim, Yoon-Nyun;Shin, Dong Gu;Lee, Chang Hee
通讯作者：
Lee, Chang Hee
影响因子：
15.8
作者：
Tucker KL;Sheppard JP;Stevens R;Bosworth HB;Bove A;Bray EP;Earle K;George J;Godwin M;Green BB;Hebert P;Hobbs FDR;Kantola I;Kerry SM;Leiva A;Magid DJ;Mant J;Margolis KL;McKinstry B;McLaughlin MA;Omboni S;Ogedegbe O;Parati G;Qamar N;Tabaei BP;Varis J;Verberk WJ;Wakefield BJ;McManus RJ
通讯作者：
McManus RJ
影响因子：
2.8
作者：
Ritchey, Matthew D.;Gillespie, Cathleen;Hong, Yuling
通讯作者：
Hong, Yuling
影响因子：
9.3
作者：
Flack, John M.;Adekola, Bemi
通讯作者：
Adekola, Bemi