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Randomized Controlled Trial
. 2023 Mar 28;40(2):414-422.
doi: 10.1093/fampra/cmac084.

Implementing a home-based virtual hypertension programme-a pilot feasibility study

Aditi Gupta  1   2   3   4 , Shellie D Ellis  5 , Crystal Burkhardt  6 , Kate Young  7 , Diego R Mazzotti  8   9 , Jonathan Mahnken  2   7 , Noor Abu-El-Rub  8 , Sravani Chandaka  8 , Branden Comfort  3 , Denton Shanks  10 , Jennifer Woodward  10 , Amber Unrein  2   4 , Heidi Anderson  2   4 , Jennifer Loucks  11 , Xing Song  12 , Lemuel R Waitman  12 , Jeffrey M Burns  2   4
Affiliations
Randomized Controlled Trial

Implementing a home-based virtual hypertension programme-a pilot feasibility study

Aditi Gupta et al. Fam Pract. .

Abstract

Introduction: Implementing a health system-based hypertension programme may lower blood pressure (BP).

Methods: We performed a randomized, controlled pilot study to assess feasibility, acceptability, and safety of a home-based virtual hypertension programme integrating evidence-based strategies to overcome current barriers to BP control. Trained clinical pharmacists staffed the virtual collaborative care clinic (vCCC) to remotely manage hypertension using a BP dashboard and phone "visits" to monitor BP, adherence, side effects of medications, and prescribe anti-hypertensives. Patients with uncontrolled hypertension were identified via electronic health records. Enrolled patients were randomized to either vCCC or usual care for 3 months. We assessed patients' home BP monitoring behaviour, and patients', physicians', and pharmacists' perspectives on feasibility and acceptability of individual programme components.

Results: Thirty-one patients (vCCC = 17, usual care = 14) from six physician clinics completed the pilot study. After 3 months, average BP decreased in the vCCC arm (P = 0.01), but not in the control arm (P = 0.45). The vCCC participants measured BP more (9.9 vs. 1.2 per week, P < 0.001). There were no intervention-related adverse events. Participating physicians (n = 6), pharmacists (n = 5), and patients (n = 31) rated all programme components with average scores of >4.0, a pre-specified benchmark. Nine adaptations in vCCC design and delivery were made based on potential barriers to implementing the programme and suggestions.

Conclusion: A home-based virtual hypertension programme using team-based care, technology, and a logical integration of evidence-based strategies is safe, acceptable, and feasible to intended users. These pilot data support studies to assess the effectiveness of this programme at a larger scale.

Keywords: geriatrics; hypertension (high blood pressure); patient adherence; patient education; primary care; self-management; telemedicine.

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Conflict of interest statement

None declared.

Figures

Fig. 1.
Fig. 1.
Blood pressure outcomes. (A) Average blood pressure in the virtual collaborative care clinic (vCCC) and usual care with education (control) arms at baseline and at 3 months. (B) Number of home blood pressure readings by week in the vCCC and usual care with education (control) arms (n = 24)*. *N = 24 as data from initial participants was excluded from this analysis. Home BP readings from the control arm were not available during the initial part of the study. Home BP readings were later made available to monitor frequency of BP monitoring.
Fig. 2.
Fig. 2.
Patient perception of (A) acceptability and (B) feasibility of the virtual collaborative care clinic (vCCC) intervention components. (A) Patient perception of acceptability. (B) Patient perception of feasibility.
Fig. 3.
Fig. 3.
Physician and pharmacist perceptions of (A) acceptability and (B) feasibility of the virtual collaborative care clinic (vCCC) intervention components at baseline and at 3 months. (A) Physician and pharmacist perceptions of acceptability. (B) Physician and pharmacist perceptions of feasibility.
See this image and copyright information in PMC

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