Implementation of Remote Patient Monitoring for Hypertension Management.

Abstract

Uncontrolled hypertension (blood pressure (BP) ≥130/80) is the most prevalent reversible risk factor for cardiovascular disease. Remote patient monitoring (RPM) can be an effective way to improve BP control and was further incentivized by the COVID-19 pandemic, which necessitated remote chronic disease management. We report on a natural experiment involving federal funding for virtual care expansion, which included home BP kits (BP cuffs, smartphones, cellular data) to facilitate RPM. We performed a mixed methods analysis of 18 health centers that requested and received BP kits, assessing device distribution, patient use, and facilitators/barriers to RPM implementation. Electronic health record (EHR) data were investigated from 2020 to 2023. Qualitative data included semistructured interviews with health center staff, patients, and programmatic staff and field notes from observations of implementation meetings. Data were analyzed following a framework-informed thematic approach. 10 of 18 health centers (56%) initiated RPM with ≥ 5 patients during the study period. A total of 1,748 patients had EHR orders to initiate RPM, of which 780 (45%) responded with <i>any</i> BP data and 271 (16%) with <i>meaningful</i> BP data. There was no correlation between RPM distribution/use and health center size or number of BP kits received. The biggest barriers to RPM uptake were inadequate health center resources and the complexity of operationalizing an RPM program in general and the BP kits specifically. Supplying free RPM hardware and cellular data plans in the absence of adequate support resources is insufficient to successfully augment care among hypertensive patients at community-based health centers.