July 23, 2013Open Access
View Full PaperBlood Pressure Control in a Hypertension Telemedicine Intervention: Does Distance to Primary Care Matter?
Key Result
Telemedicine did not significantly improve 18-month systolic blood pressure compared to usual care for patients living ≥30 miles (difference -0.80 mm Hg; 95% CI -6.6 to 5.1) or <30 miles away.
Study Design
Type
Observational (n=503)
Structured PICO
Does a telemedicine intervention improve 18-month systolic blood pressure in veterans with hypertension, and does travel distance to primary care matter?
P
Population
503 veterans participating in a hypertension telemedicine study
I
Intervention
Telemedicine intervention (categorized by travel distance <30 miles or ≥30 miles)
C
Comparator
Usual care (categorized by travel distance <30 miles or ≥30 miles)
O
Outcome
18-month systolic blood pressure (SBP)surrogate
A telemedicine intervention did not significantly improve 18-month systolic blood pressure compared to usual care, regardless of the patient's travel distance to primary care.
Main Result
Effect estimate: Difference -0.80 mm Hg (95% CI -6.6 to 5.1)
Abstract
Although telemedicine may help overcome geographic access barriers, it is unknown whether rural patients receive greater benefits. In a secondary analysis of 503 veterans participating in a hypertension telemedicine study, the authors hypothesized that patients with greater travel distances would have greater improvements in 18-month systolic blood pressure (SBP). Patients were categorized by telemedicine exposure and travel distance to primary care, derived from zip codes. Comparisons were (1) usual care (UC), distance <30 miles (reference); (2) UC, distance ≥30 miles; (3) telemedicine, distance <30 miles; (4) telemedicine, distance ≥30 miles. Compared with patients receiving UC, distance <30 miles (intercept=127.7), no difference in 18-month SBP was observed in patients receiving UC, distance ≥30 miles (0.13 mm Hg, 95% confidence interval -6.6 to 6.8); telemedicine, distance <30 miles (-1.1 mm Hg -7.3 to 5.2); telemedicine, distance ≥30 miles (-0.80 mm Hg -6.6 to 5.1). Although telemedicine may help overcome geographic access barriers, additional studies are needed to identify patients most likely to benefit.