Enhancing patient engagement and blood pressure management for renal transplant recipients via home electronic monitoring and web-enabled collaborative care

Abstract

Background: Effective management of hypertension in chronic kidney disease and renal transplantation is a clinical priority and has societal implications in terms of preserving and optimizing the value of scarce organs. However, hypertension is optimally managed in only 37% of people with chronic kidney disease, and poor control can contribute to premature graft loss in renal transplant recipients. This article describes a telehealth system that incorporates home electronic blood pressure (BP) monitoring and uploading to a patient portal coupled with a Web-based dashboard that enables clinical pharmacist collaborative care in a renal transplant clinic.

Materials and methods: The telehealth system was developed and implemented as a quality improvement initiative in a renal transplant clinic in a large, 700-bed, urban hospital with the aim of improving BP in posttransplant patients. A convenience sample of 66 posttransplant patients was recruited by the clinical pharmacist from consecutive referrals to the Transplant Clinic.

Results: Preliminary results show statistically significant reductions in average systolic and diastolic BP of 6.0 mm Hg and 3.0 mm Hg, respectively, at 30 days after enrollment. Two case reports describe the instrumental role of home BP monitoring in the context of medication therapy management.

Conclusions: Optimizing BP control for both pre- and post-renal transplant patients is likely to benefit society in terms of preserving scarce resources and reducing healthcare costs due to premature graft failure. Connected health systems hold great promise for supporting team-based care and improved health outcomes.

Keywords: e-health; home health monitoring; pharmacy; telehealth; telemedicine.

Fig. 1.

Patient's personalized blood pressure (BP) monitoring page. This page is synchronized with HealthVault. Multiple time periods are available for patients to select for viewing.

Fig. 2.

Pharmacist Dashboard depicting the status of an individual patient's adherence to blood pressure (BP) monitoring and relevant parameters. The clinical pharmacist can augment the Dashboard with encounter notes. DOB, date of birth; N/A, not available; Rx/RX, prescription.