Piloting a team-based telemedicine care for hypertension focused on black patients

BACKGROUND: Current telemedicine programs to manage hypertension are less effective in Black compared with White patients in the US. Insufficient support for self-care skills and unaddressed social needs may explain the differences. We evaluated feasibility of a team-based telemedicine program using home blood pressure (BP) monitoring (HBPM) guided pharmacotherapy and supporting patients' self-care skills and social needs. 

METHODS: We conducted a single-arm pilot study in two safety-net clinics in North Carolina, enrolling 20 adults with uncontrolled hypertension on stable antihypertensive regimen with smartphone access, and English proficiency. We excluded individuals with conditions impairing home BP monitoring, complex chronic illnesses, or recent acute health events. The 12-week intervention included daily HBPM, HBPM-guided pharmacotherapy, telephone-based self-management support by trained nurses, and social support from community health workers (CHW) and social workers. We evaluated feasibility for recruitment and retention and completion of intervention components, pre-specified as ≥ 70% of expected HBPM (7 times/week/patient) and ≥ 80% self-management calls/patient (8 in clinic 1 and 12 in clinic 2). 

RESULTS: Among 135 patients approached, 28.9% (n = 39) were eligible. We enrolled 20 patients (17 Black patients, 9 women) and 18 (90%) completed the study. Patients measured their BP an average of 9.4 (SD 8.6) times/week (134.3% of expected) and completed 78.3% of expected calls. We provided social support to 11 patients 19 times including support at home visits by CHWs, mostly for food and medications. There were challenges in supporting other social needs like housing. There was mean (SD) of 1.1 (0.8) medication activation/patient (dose or medication changes), and 8 minor technical issues about HBPM/telemonitoring application use, which were promptly resolved. 

CONCLUSION: Our team-based telemedicine hypertension intervention shows feasibility for recruitment, retention, and HBPM, partial feasibility for social support, and almost met feasibility for self-management support. Community informed approaches can further improve program implementation.