BMC Med Inform Decis Mak - Home based telemedicine intervention for patients with uncontrolled hypertension--a real life non-randomized study.

Tópicos

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Resumo

CKGROUND: Control of blood pressure is frequently inadequate in spite of availability of several classes of well tolerated and effective antihypertensive drugs. Several factors, including the use of suboptimal doses of drugs, inadequate or ineffective treatments and poor drug compliance may be the reason for this phenomenon. The aim of the current non- randomized study was to evaluate the effectiveness of a Home-Based Telemedicine service in patients with uncontrolled hypertension.METHODS: 74 patients were enrolled in a Home Based Telemedicine group and 94 patients in the Usual Care group. At baseline and at the end of the study, patients in both groups were seen in a cardiology office. Patients in Home Based Telemedicine group additionally were followed by a physician-nurse, through scheduled and unscheduled telephone appointments. These patients also received a blood pressure measuring device that could transmit the readings to a central data monitor via secure data connection.RESULTS: During the study period (80 ? 25 days), a total of 17401 blood pressure measurements were taken in the Home Based Telemedicine group corresponding to 236 ? 136 readings per patient and a mean daily measurement of 3 ? 1.7. The scheduled telephone contacts (initiated by the nurse) equaled to 5.2 ? 4.3/patient (370 in total) and the unscheduled telephone contacts (initiated by the patients) were 0.4 ? 0.9/patient (30 in total). The mean systolic blood pressure values decreased from 153 ? 19 mmHg to 130 ? 15 mmHg (p < 0.0001) at the end of the study and diastolic blood pressure values decreased from 89 ? 10 mmHg to 76 ? 11 mmHg (p < 0.0001). In the Usual Care group, the mean systolic blood pressure values decreased from 156 ? 16 mmHg to 149 ? 17 mmHg (p < 0.05) at the end of the study and diastolic blood pressure values decreased from 90 ? 8 mmHg to 86 ? 9 mmHg (p < 0.05). The changes in drug therapy initiated following telephone contacts were 1.81 ? 1.73 per patient.CONCLUSIONS: The addition of a structured physician-nurse approach supported by remote telemonitoring of blood pressure is likely to improve outcome in patients with uncontrolled hypertension.

Resumo Limpo

ckground control blood pressur frequent inadequ spite avail sever class well toler effect antihypertens drug sever factor includ use suboptim dose drug inadequ ineffect treatment poor drug complianc may reason phenomenon aim current non random studi evalu effect homebas telemedicin servic patient uncontrol hypertensionmethod patient enrol home base telemedicin group patient usual care group baselin end studi patient group seen cardiolog offic patient home base telemedicin group addit follow physiciannurs schedul unschedul telephon appoint patient also receiv blood pressur measur devic transmit read central data monitor via secur data connectionresult studi period day total blood pressur measur taken home base telemedicin group correspond read per patient mean daili measur schedul telephon contact initi nurs equal patient total unschedul telephon contact initi patient patient total mean systol blood pressur valu decreas mmhg mmhg p end studi diastol blood pressur valu decreas mmhg mmhg p usual care group mean systol blood pressur valu decreas mmhg mmhg p end studi diastol blood pressur valu decreas mmhg mmhg p chang drug therapi initi follow telephon contact per patientconclus addit structur physiciannurs approach support remot telemonitor blood pressur like improv outcom patient uncontrol hypertens

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