Document Detail

Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries.
MedLine Citation:
PMID:  23061642     Owner:  NLM     Status:  In-Data-Review    
Abstract Objective: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. Subjects and Methods: This was a randomized trial with a 6-week follow-up. Participants with high SBPs (≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medication-related problems. Results: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p=0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg (-14.2, -3.4, p=0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p=0.004), fewer medication problems (p<0.0001), better general health (p<0.0001), and greater satisfaction with care (p≤0.004). Conclusions: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.
John D Piette; Hema Datwani; Sofia Gaudioso; Stephanie M Foster; Joslyn Westphal; William Perry; Joel Rodríguez-Saldaña; Milton O Mendoza-Avelares; Nicolle Marinec
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Telemedicine journal and e-health : the official journal of the American Telemedicine Association     Volume:  18     ISSN:  1556-3669     ISO Abbreviation:  Telemed J E Health     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100959949     Medline TA:  Telemed J E Health     Country:  United States    
Other Details:
Languages:  eng     Pagination:  613-20     Citation Subset:  IM    
1 Ann Arbor VA Healthcare System , Ann Arbor, Michigan.
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