Patients with hypertension who monitor their blood pressure from home and receive web-based pharmacist care show greater improvement in blood pressure control than patients who receive usual care, according to a study in the June 25 issue of JAMA.
Researchers at Group Health Center for Health Studies in Seattle tested whether hypertension care could be successfully provided remotely over the web without in-person clinic visits.
Care was delivered over a secure patient website from June 2005 to December 2007. The website included online services such as patients being able to send email to their physician, refilling prescriptions, requesting appointments, getting test results and looking up health information.
Participants were randomly assigned to usual care, home BP monitoring and secure patient website training only, or home BP monitoring and secure patient website training plus care management by a pharmacist delivered through web communications.
The researchers found that compared with patients receiving usual care, the BP control of the home BP monitoring and web training only group had a nonsignificant increase in the percentage of patients with controlled BP.
The addition of web-based pharmacist care to home BP monitoring and web training resulted in 25% more patients with controlled BP (56%) compared with those receiving usual care (31%) and 20% more patients with controlled BP compared with the home BP monitoring and web training only group (36%).
Compared with usual care, greater reductions in systolic BP occurred in the group receiving home BP monitoring and web training plus pharmacist care, and in the group receiving home BP monitoring and web training only. The group receiving home BP monitoring and web training plus pharmacist care also had a significant decrease in diastolic BP compared with the group receiving usual care.
For the group with baseline systolic BP of 160mmHg or higher, the group receiving home BP monitoring and web training plus pharmacist care had 3.3 times more patients with BP in control, compared with usual care.
"We believe the pharmacists were successful because they provided planned care to a defined population, consistently applied stepped medication protocols, and used comprehensive information systems, a patient-shared EMR (electronic medical record), and web communications to collaborate with patients and their physicians," the authors write.