Key Components of Success in a Randomized Trial of Blood Pressure Telemonitoring with Medication Therapy Management (MTM) Pharmacists

Abstract

Objectives:

The Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72% vs. 45%, P < 0.001) and 12 months (71% vs. 53%, P =.005). We sought to investigate factors contributing to intervention success.

Design:

Mixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews.

Setting and Participants:

Data from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified.

Outcome measures:

Home BP readings of <135/85 mmHg and patient focus group and pharmacist interview themes.

Results:

Mean BP at the intake visit was 148/85 mmHg. Antihypertensive medications were adjusted in 10% of patients at the initial in-person visit, 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mmHg, 126/74 mmHg at 3 months, and 123/73 mmHg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient/pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist.

Conclusion:

Frequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive phone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.

Trial registration:

https://www.ClinicalTrials.gov [Related object:]. Registered 28 October 2008.