Patients Satisfied with Going Online to Get Blood Pressure in Line

Data unveiled today at the American Society of Hypertension's Twenty Fourth Annual Scientific Meeting (ASH 2009) demonstrate that, while receiving Web-based pharmacist care, patients with hypertension are more engaged and no less satisfied with their care than when receiving usual care. They initiate more contact with their physician and are no less satisfied with their primary care team despite the lack of traditional face-to-face contact. These improvements were seen despite widespread concerns that decreased contact with physicians could negatively impact treatment progress.

The new results come from the Electronic Communications and Home Blood Pressure Monitoring (e-BP) trial that the Journal of the American Medical Association published on June 25, 2008. The e-BP trial results reported earlier showed that Group Health patients’ blood pressure (BP) control improved more when they monitored it from home and received Web-based pharmacist care. Impressed by those results, Group Health Cooperative, a Seattle-based nonprofit health system coordinating care and coverage, is gradually rolling out home monitoring and Web-based pharmacist care as standard care for its patients with hypertension.

Evidence is strong that lowering BP in patients with hypertension decreases cardiovascular disease, yet BP is still inadequately controlled. Despite effective therapies, only about one-third of treated patients with hypertension in the U.S. have their BP lowered to target goals. Additional research suggests that changes in team structure such as adding a pharmacist assigned to manage hypertension care leads to improved treatment choices. However, concern is ongoing that using ancillary care providers will result in decreased patient satisfaction and engagement in their care.

“We have known for a while that a key factor in improving treatment outcomes involves encouraging patients to actively participate in their own care,” said lead author Beverly B. Green, M.D., MPH, a family doctor and researcher at Group Health. “However, this study was the first to reveal that connecting patients and pharmacists through a shared electronic medical record over the Web helps people with high blood pressure take a more proactive approach to their treatment and may account for their improved health outcomes.”

The e-BP trial tested two interventions against usual care: 1) home blood pressure monitoring and training on its use and a Group Health secure patient Web site or 2) this plus pharmacist care management. All patients received information on blood-pressure control and were registered and given information on the patient Web site, which included online services such as the ability to send emails to their physician, refill prescriptions, request appointments, obtain test results, and look up health information. Those receiving home BP monitoring plus Web-based pharmacy care had a net reduction in systolic BP of 9 mm Hg and diastolic BP of 3.5 mm Hg compared to usual care (P <0.001) and were 25 percent more likely to have controlled hypertension (BP <140/90 mm Hg; P <0.001). Results showed that patient satisfaction with their medical care did not decrease, and patients in the pharmacy group showed more engagement because they were more likely to generate email communications to their healthcare team.