Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes.

OBJECTIVE Patient self-management support may be augmented by using home-based technologies that generate data points that providers can potentially use to make more timely changes in the patients' care. The purpose of this study was to evaluate the effectiveness of short-term targeted use of remote data transmission on treatment outcomes in patients with diabetes who had either out-of-range hemoglobin A1c (A1c) and/or blood pressure (BP) measurements. MATERIALS AND METHODS A single-center randomized controlled clinical trial design compared in-home monitoring (n=55) and usual care (n=53) in patients with type 2 diabetes and hypertension being treated in primary care clinics. Primary outcomes were A1c and systolic BP after a 12-week intervention. RESULTS There were no significant differences between the intervention and control groups on either A1c or systolic BP following the intervention. CONCLUSIONS The addition of technology alone is unlikely to lead to improvements in outcomes. Practices need to be selective in their use of telemonitoring with patients, limiting it to patients who have motivation or a significant change in care, such as starting insulin. Attention to the need for effective and responsive clinic processes to optimize the use of the additional data is also important when implementing these types of technology.

[1]  H. Krumholz,et al.  Telemonitoring in patients with heart failure. , 2010, The New England journal of medicine.

[2]  Kate McMillan,et al.  A cross-sectional survey and service evaluation of simple telehealth in primary care: what do patients think? , 2012, BMJ Open.

[3]  Bonnie J Wakefield,et al.  Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[4]  William Branch,et al.  Clinical Inertia , 2001, Annals of Internal Medicine.

[5]  Emma P Bray,et al.  Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study. , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  Lauren Hovey,et al.  Community-based telemonitoring for hypertension management: practical challenges and potential solutions. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[7]  M. Boaz,et al.  An automated telemedicine system improves patient-reported well-being. , 2009, Diabetes technology & therapeutics.

[8]  R. Light,et al.  Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control: A Systematic Review and Meta-Analysis , 2011, Hypertension.

[9]  Suzanne Bakken,et al.  The Role of Nurses in Installing Telehealth Technology in the Home , 2005, Computers, informatics, nursing : CIN.

[10]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[11]  Majd Alwan,et al.  Impact of blood pressure telemonitoring on hypertension outcomes: a literature review. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[12]  N. van den Berg,et al.  Implementing telemonitoring in the daily routine of a GP practice in a rural setting in northern Germany , 2007, Journal of telemedicine and telecare.

[13]  M. Sevick,et al.  Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes , 2009, Diabetes Care.

[14]  L. Tarassenko,et al.  Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study. , 2009, Informatics in primary care.

[15]  F. Cappuccio,et al.  Blood pressure control by home monitoring: meta-analysis of randomised trials , 2004, BMJ : British Medical Journal.

[16]  Valerie Smith,et al.  Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. , 2011, Archives of internal medicine.

[17]  G. Paré,et al.  Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review , 2010, Journal of medical Internet research.

[18]  J. Kvedar,et al.  Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application , 2009, Journal of diabetes science and technology.

[19]  George Hripcsak,et al.  Application of Information Technology: Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: Technical Implementation , 2002, J. Am. Medical Informatics Assoc..

[20]  Mario Pascual Carrasco,et al.  Impact of Patient–General Practitioner Short-Messages-Based Interaction on the Control of Hypertension in a Follow-up Service for Low-to-Medium Risk Hypertensive Patients: A Randomized Controlled Trial , 2008, IEEE Transactions on Information Technology in Biomedicine.

[21]  Richard J McManus,et al.  Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial , 2010, The Lancet.

[22]  Jean-Paul Fortin,et al.  Impacts of telehomecare on patients, providers, and organizations. , 2006, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[23]  Guy Paré,et al.  Review Paper: Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base , 2007, J. Am. Medical Informatics Assoc..

[24]  J. WakefieldBonnie,et al.  Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes. , 2014 .