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Telemonitoring improves blood pressure control, but increases costs

Home telemonitoring moderately improves blood pressure control, compared with usual care, but increases costs say Scottish researchers.

The study

Researchers studied 401 adult patients with uncontrolled high blood pressure (defined as 135/85 mmHg or above) from 20 Scottish GP practices. Half of the patients were randomised to take their own blood pressure and transmit readings to a secure website for subsequent review with their GP or nurse, for six months. The other half of the patients received usual care, going into their practice for blood pressure checks according to the usual routine of the practice.

The findings

Mean blood pressure fell by more in the telemonitoring arm, from 146.0 mmHg to 140.0 mmHg, and in the usual care arm, in which it fell from 146.5 mmHg to 144.3 mmHg. This equated to a statistically significant 4.3 mmHg greater reduction in blood pressure with telemonitoring, after adjustment for baseline confounders including mean daytime systolic ambulatory blood pressure. In addition, more patients receiving the telemonitoring support had an increase in the number of antihypertensive drugs prescribed, compared with those receiving usual care.

But excluding hospital admissions, costs per patient were on average £109.32 higher over the six-month period with telemonitoring than usual care. This was driven mainly by the cost of the monitor, mobile phone and connection charges, the server and web hosting and the time taken for nurses to check the website. On average there was one additional GP consultation in the telemonitoring group, compared with the usual care group, which cost an extra £32.89, and additional nurse costs.

What this means for GPs

The authors concluded that supported telemonitoring resulted in clinically important reductions in blood pressure in a group of patients with uncontrolled blood pressure, but was associated with increased use of NHS resources. They concluded: ‘Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost-effective.’

BMJ 2013; 346: f3030

 

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