Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: A randomized controlled trial

Beverly B. Green, Andrea J. Cook, James D. Ralston, Paul A. Fishman, Sheryl L Catz, James Carlson, David Carrell, Lynda Tyll, Eric B. Larson, Robert S. Thompson

Research output: Contribution to journalArticle

405 Citations (Scopus)

Abstract

Context: Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled. Objective: To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, and pharmacist-assisted care improves BP control. Design, Setting, and Participants: A 3-group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007. Interventions: Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications. Main Outcome Measures: Percentage of patients with controlled BP (<140/90 mm Hg) and changes in systolic and diastolic BP at 12 months. Results Of 778 patients, 730 (94%) completed the 1-year follow-up visit. Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP (<140/90 mm Hg) compared with usual care (36% [95% confidence interval {CI}, 30%-42%] vs 31% [95% CI, 25%-37%]; P=.21). Adding Web-based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP (56%; 95% CI, 49%-62%) compared with usual care (P<.001) and home BP monitoring and Web training only (P<.001). Systolic BP was decreased stepwise from usual care to home BP monitoring and Web training only to home BP monitoring and Web training plus pharmacist care. Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and Web training only groups. Compared with usual care, the patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and Web training plus pharmacist care had a greater net reduction in systolic BP (-13.2 mm Hg [95% CI, -19.2 to -7.1]; P<.001) and diastolic BP (-4.6 mm Hg [95% CI, -8.0 to -1.2]; P<.001), and improved BP control (relative risk, 3.32 [95% CI, 1.86 to 5.94];P<.001). Conclusion: Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension. Trial Registration: clinicaltrials.gov Identifier: NCT00158639.

Original languageEnglish (US)
Pages (from-to)2857-2867
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume299
Issue number24
DOIs
StatePublished - Jun 25 2008
Externally publishedYes

Fingerprint

Ambulatory Blood Pressure Monitoring
Pharmacists
Randomized Controlled Trials
Communication
Blood Pressure
Hypertension
Confidence Intervals
Patient Care
Group Practice

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control : A randomized controlled trial. / Green, Beverly B.; Cook, Andrea J.; Ralston, James D.; Fishman, Paul A.; Catz, Sheryl L; Carlson, James; Carrell, David; Tyll, Lynda; Larson, Eric B.; Thompson, Robert S.

In: JAMA - Journal of the American Medical Association, Vol. 299, No. 24, 25.06.2008, p. 2857-2867.

Research output: Contribution to journalArticle

Green, Beverly B. ; Cook, Andrea J. ; Ralston, James D. ; Fishman, Paul A. ; Catz, Sheryl L ; Carlson, James ; Carrell, David ; Tyll, Lynda ; Larson, Eric B. ; Thompson, Robert S. / Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control : A randomized controlled trial. In: JAMA - Journal of the American Medical Association. 2008 ; Vol. 299, No. 24. pp. 2857-2867.
@article{1c6c07b43b7d4d7b99780005e733bdab,
title = "Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: A randomized controlled trial",
abstract = "Context: Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled. Objective: To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, and pharmacist-assisted care improves BP control. Design, Setting, and Participants: A 3-group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007. Interventions: Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications. Main Outcome Measures: Percentage of patients with controlled BP (<140/90 mm Hg) and changes in systolic and diastolic BP at 12 months. Results Of 778 patients, 730 (94{\%}) completed the 1-year follow-up visit. Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP (<140/90 mm Hg) compared with usual care (36{\%} [95{\%} confidence interval {CI}, 30{\%}-42{\%}] vs 31{\%} [95{\%} CI, 25{\%}-37{\%}]; P=.21). Adding Web-based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP (56{\%}; 95{\%} CI, 49{\%}-62{\%}) compared with usual care (P<.001) and home BP monitoring and Web training only (P<.001). Systolic BP was decreased stepwise from usual care to home BP monitoring and Web training only to home BP monitoring and Web training plus pharmacist care. Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and Web training only groups. Compared with usual care, the patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and Web training plus pharmacist care had a greater net reduction in systolic BP (-13.2 mm Hg [95{\%} CI, -19.2 to -7.1]; P<.001) and diastolic BP (-4.6 mm Hg [95{\%} CI, -8.0 to -1.2]; P<.001), and improved BP control (relative risk, 3.32 [95{\%} CI, 1.86 to 5.94];P<.001). Conclusion: Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension. Trial Registration: clinicaltrials.gov Identifier: NCT00158639.",
author = "Green, {Beverly B.} and Cook, {Andrea J.} and Ralston, {James D.} and Fishman, {Paul A.} and Catz, {Sheryl L} and James Carlson and David Carrell and Lynda Tyll and Larson, {Eric B.} and Thompson, {Robert S.}",
year = "2008",
month = "6",
day = "25",
doi = "10.1001/jama.299.24.2857",
language = "English (US)",
volume = "299",
pages = "2857--2867",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "24",

}

TY - JOUR

T1 - Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control

T2 - A randomized controlled trial

AU - Green, Beverly B.

AU - Cook, Andrea J.

AU - Ralston, James D.

AU - Fishman, Paul A.

AU - Catz, Sheryl L

AU - Carlson, James

AU - Carrell, David

AU - Tyll, Lynda

AU - Larson, Eric B.

AU - Thompson, Robert S.

PY - 2008/6/25

Y1 - 2008/6/25

N2 - Context: Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled. Objective: To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, and pharmacist-assisted care improves BP control. Design, Setting, and Participants: A 3-group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007. Interventions: Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications. Main Outcome Measures: Percentage of patients with controlled BP (<140/90 mm Hg) and changes in systolic and diastolic BP at 12 months. Results Of 778 patients, 730 (94%) completed the 1-year follow-up visit. Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP (<140/90 mm Hg) compared with usual care (36% [95% confidence interval {CI}, 30%-42%] vs 31% [95% CI, 25%-37%]; P=.21). Adding Web-based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP (56%; 95% CI, 49%-62%) compared with usual care (P<.001) and home BP monitoring and Web training only (P<.001). Systolic BP was decreased stepwise from usual care to home BP monitoring and Web training only to home BP monitoring and Web training plus pharmacist care. Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and Web training only groups. Compared with usual care, the patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and Web training plus pharmacist care had a greater net reduction in systolic BP (-13.2 mm Hg [95% CI, -19.2 to -7.1]; P<.001) and diastolic BP (-4.6 mm Hg [95% CI, -8.0 to -1.2]; P<.001), and improved BP control (relative risk, 3.32 [95% CI, 1.86 to 5.94];P<.001). Conclusion: Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension. Trial Registration: clinicaltrials.gov Identifier: NCT00158639.

AB - Context: Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled. Objective: To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, and pharmacist-assisted care improves BP control. Design, Setting, and Participants: A 3-group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007. Interventions: Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications. Main Outcome Measures: Percentage of patients with controlled BP (<140/90 mm Hg) and changes in systolic and diastolic BP at 12 months. Results Of 778 patients, 730 (94%) completed the 1-year follow-up visit. Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP (<140/90 mm Hg) compared with usual care (36% [95% confidence interval {CI}, 30%-42%] vs 31% [95% CI, 25%-37%]; P=.21). Adding Web-based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP (56%; 95% CI, 49%-62%) compared with usual care (P<.001) and home BP monitoring and Web training only (P<.001). Systolic BP was decreased stepwise from usual care to home BP monitoring and Web training only to home BP monitoring and Web training plus pharmacist care. Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and Web training only groups. Compared with usual care, the patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and Web training plus pharmacist care had a greater net reduction in systolic BP (-13.2 mm Hg [95% CI, -19.2 to -7.1]; P<.001) and diastolic BP (-4.6 mm Hg [95% CI, -8.0 to -1.2]; P<.001), and improved BP control (relative risk, 3.32 [95% CI, 1.86 to 5.94];P<.001). Conclusion: Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension. Trial Registration: clinicaltrials.gov Identifier: NCT00158639.

UR - http://www.scopus.com/inward/record.url?scp=45849123267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=45849123267&partnerID=8YFLogxK

U2 - 10.1001/jama.299.24.2857

DO - 10.1001/jama.299.24.2857

M3 - Article

C2 - 18577730

AN - SCOPUS:45849123267

VL - 299

SP - 2857

EP - 2867

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 24

ER -