Does automated telephone care management plus home blood pressure monitoring reduce systolic blood pressure in hypertensive patients in low/middle-income countries?
Automated telephone care management combined with home blood pressure monitoring can improve systolic blood pressure and patient-reported outcomes in hypertensive patients in low/middle-income countries, particularly among those with high information needs.
OBJECTIVE: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. SUBJECTS AND METHODS: This was a randomized trial with a 6-week follow-up. Participants with high SBPs (≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medication-related problems. RESULTS: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was 2, 900 USD, and average educational attainment was 6. 5 years. At follow-up intervention patients' SBPs decreased 4. 2 mm Hg relative to controls (95% confidence interval -9. 1, 0. 7; p=0. 09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8. 8 mm Hg (-14. 2, -3. 4, p=0. 002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p=0. 004), fewer medication problems (p<0. 0001), better general health (p<0. 0001), and greater satisfaction with care (p≤0. 004). CONCLUSIONS: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.
Piette et al. (Mon,) studied this question.
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