Remote Monitoring of Blood Pressure and Clinician Decisions

Quick Takes

  • Electronic health record alerts for elevated blood pressure (BP) were associated with increases in medication changes and provider-patient contacts (remote and in-person visits) for approximately 60% of alerts.
  • Improving documentation of rationale for lack of change in BP management was significant, suggesting room for designing and implementing interventions to increase response to BP alerts and documenting changes in care plans.

Study Questions:

Do alerts for elevated blood pressure (BP) measured in remote monitoring programs result in changes in BP-related care plans?

Methods:

This retrospective study was conducted in a single urban academic family practice site between May 2018 and August 2019. Primary care teams included 28 attending physicians, nurse practitioners, residents, and nurses who provided care for 162 patients using a text-based clinical trial of remote monitoring for BP. Providers received a direct message in their electronic health record (EHR) inbox when a patient submitted three or more elevated BP readings. The primary outcome was clinician responses to EHR alerts, including medication changes and clinical visits.

Results:

A total of 162 patients (68.5% female, 90.1% Black or African American) were included in the study. Five hundred and fifty-two alerts fell into 12 categories of clinical actions. Clinicians acted on 343 alerts (62.1%). Common remote activities were to reconcile medications and assess adherence (120 of 552 alerts [21.7%]) and to verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly requested appointments (120 of 552 alerts [21.7%]) and/or saw the patient in a subsequent office visit (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes; half of these changes were remote (48 of 96 [50.0%]), and the other half were visit-based. For 209 of 552 alerts (37.9%), no changes were made to the care plan; for the majority (93.8%), no documentation of clinical rationale was provided.

Conclusions:

The investigators concluded that these findings suggest that EHR alerts for elevated BP during remote monitoring were effective in prompting a mix of remote and office-based management. However, it was also common for the plan of care to remain unchanged, possibly suggesting the need for more refined alerts and improved clinician support.

Perspective:

These data suggest that remote monitoring for BP can assist providers with BP control. However, given the size of the study, large-scale studies, perhaps with associated outcomes including patient satisfaction, verified BP measures, and medication adherence, may be helpful. Additionally, assessment for alert fatigue may be a relevant outcome in these types of interventions.

Keywords: African Americans, Blood Pressure, Electronic Health Records, Health Plan Implementation, Medication Adherence, Office Visits, Nurse Practitioners, Primary Prevention, Primary Health Care, Telemedicine


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