Impact of Telemedicine Use on Blood Pressure Control During the Covid-19 Pandemic: A Cohort Study (Preprint)

2021 ◽  
Author(s):  
Siqin Ye ◽  
D. Edmund Anstey ◽  
Anne Grauer ◽  
Gil Metser ◽  
Nathalie Moise ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pressure Control ◽  
Care Quality ◽  
Academic Medical ◽  
Cardiovascular Care

BACKGROUND Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care quality. OBJECTIVE We sought to examine the association between telemedicine use and blood pressure (BP) control. METHODS This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. RESULTS During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<.001 for 2+ telemedicine visits; reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=.03 for 2+ telemedicine visits). CONCLUSIONS BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded. CLINICALTRIAL NA

scholarly journals Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Jennifer P Stevens ◽  
Oren Mechanic ◽  
Lawrence Markson ◽  
Ashley O'Donoghue ◽  
Alexa B Kimball
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Disparities ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Race And Gender ◽  
Asian Patients ◽  
Academic Medical

BACKGROUND During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. OBJECTIVE Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. METHODS Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. RESULTS At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. CONCLUSIONS Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities.

Effects From Continuous Infusions of Dexmedetomidine and Propofol on Hemodynamic Stability in Critically Ill Adult Patients With Septic Shock

2018 ◽  
Vol 35 (9) ◽  
pp. 875-880 ◽  
Author(s):  
Kristen M. Nelson ◽  
Gourang P. Patel ◽  
Drayton A. Hammond
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hemodynamic Stability ◽  
Lengths Of Stay ◽  
Academic Medical ◽  
Clinically Significant

Purpose: To compare the development of clinically significant hemodynamic event (ie, hypotension or bradycardia) in adults with septic shock receiving either propofol or dexmedetomidine. Materials and Methods: A retrospective cohort study of adults with septic shock admitted to an intensive care unit (ICU) at an academic medical center between July 2013 and July 2017. Results: Patients in the propofol (n = 35) and dexmedetomidine (n = 37) groups developed a clinically significant hemodynamic event at similar frequencies (31.4 vs 29.7%, P = .99). All patients with an event experienced hypotension, whereas 2 (5.4%) patients in the dexmedetomidine group also experienced bradycardia. Most patients in both groups (70% vs 90%) received an escalating sedative dose, and almost half (42.9%) in the dexmedetomidine group had the sedative dosage increased more frequently than every 30 minutes. Patients in both groups had similar ICU (24.1 vs 24.3 days, P = .98) and hospital (37.9 vs 29.7 days, P = .29) lengths of stay. There was no difference in median time to hemodynamic event between the groups (propofol 1 hour [interquartile range, IQR: 0.5-9.9] vs dexmedetomidine 2 hours [IQR: 1.5-11.1 hours], P = .85). Conclusion: Patients with septic shock receiving propofol or dexmedetomidine experienced similar rates of clinically significant hemodynamic events. Most patients did not experience an event and those who did most frequently did so in the first couple of hours of therapy.

scholarly journals Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015743 ◽  
Author(s):  
Derbew Fikadu Berhe ◽  
Katja Taxis ◽  
Flora M Haaijer-Ruskamp ◽  
Afework Mulugeta ◽  
Yewondwossen Tadesse Mengistu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pressure Control ◽  
Public Hospitals ◽  
Multivariable Logistic Regression Analysis ◽  
Treatment Intensification ◽  
Treatment Regimens ◽  
Ambulatory Patients

ObjectivesWe examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP).DesignA retrospective cohort study in six public hospitals, Ethiopia.ParticipantsAdult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital.OutcomeControlled BP (<140/90 mm Hg) and treatment intensification of patients with uncontrolled BP.ResultsThe study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant—positive—determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09).ConclusionsThe level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.

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