Adoption of Telehealth: Remote Biometric Monitoring among Peritoneal Dialysis Patients in the United States

2017 ◽  
Vol 37 (5) ◽  
pp. 576-578 ◽  
Author(s):  
Susie Q. Lew ◽  
Neal Sikka ◽  
Clinton Thompson ◽  
Teena Cherian ◽  
Manya Magnus
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Real Time ◽  
Remote Monitoring ◽  
Call Center ◽  
The United States ◽  
Self Monitoring ◽  
Frequency Of Use ◽  
The Relationship ◽  
Monitoring Devices

We examined participant uptake and utilization of remote monitoring devices, and the relationship between remote biometric monitoring (RBM) of weight (Wt) and blood pressure (BP) with self-monitoring requirements. Participants on peritoneal dialysis (PD) (n = 269) participated in a Telehealth pilot study of which 253 used remote monitoring of BP and 255 for Wt. Blood pressure and Wt readings were transmitted in real time to a Telehealth call center, which were then forwarded to the PD nurses for real-time review. Uptake of RBM was substantial, with 89.7% accepting RBM, generating 74,266 BP and 52,880 Wt measurements over the study period. We found no significant correlates of RBM uptake with regard to gender, marital, educational, socio-economic or employment status, or baseline experience with computers; frequency of use of BP RBM by Black participants was less than non-Black participants, as was Wt RBM, and participants over 55 years old were more likely to use the Wt RBM than their younger counterparts. Having any review of the breach by a nurse was associated with reduced odds of a subsequent BP breach after adjusting for sex, age, and race. Remote biometric monitoring was associated with adherence to self-monitoring BP and Wt requirements associated with PD. Remote biometric monitoring was feasible, allowing for increased communication between patient and PD clinical staff with real-time patient data for providers to act on to potentially improve adherence and outcomes.

scholarly journals Design of the Pregnancy REmote MOnitoring II study (PREMOM II): a multicenter, randomized controlled trial of remote monitoring for gestational hypertensive disorders

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dorien Lanssens ◽  
◽  
Inge M. Thijs ◽  
Wilfried Gyselaers
Keyword(s):  
Blood Pressure ◽  
Remote Monitoring ◽  
Antihypertensive Medication ◽  
Neonatal Outcomes ◽  
Self Monitoring ◽  
Link Type ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Multicenter Randomized Controlled Trial ◽  
Patient Reported

Abstract Background Observational data from the retrospective, non-randomized Pregnancy REmote MOnitoring I (PREMOM I) study showed that remote monitoring (RM) may be beneficial for prenatal observation of women at risk for gestational hypertensive disorders (GHD) in terms of clinical outcomes, health economics, and stakeholder perceptions. PREMOM II is a prospective, randomized, multicenter follow-up study that was performed to explore these promising results. Methods After providing written consent, 3922 pregnant women aged ≥18 years who are at increased risk of developing GHD will be randomized (1:1:1 ratio) to (a) conventional care (control group), (b) a patient self-monitoring group, and (c) a midwife-assisted RM group. The women in each group will be further divided (1:1 ratio) to evaluate the outcomes of targeted or non-targeted (conventional) antihypertensive medication. Women will be recruited in five hospitals in Flanders, Belgium: Ziekenhuis Oost-Limburg, Universitaire Ziekenhuis Antwerpen, Universitaire Ziekenhuis Leuven, AZ Sint Jan Brugge–Oostende, and AZ Sint Lucas Brugge. The primary outcomes are: (1) numbers and types of prenatal visits; (2) maternal outcomes; (3) neonatal outcomes; (4) the applicability and performance of RM; and (5) compliance with RM and self-monitoring. The secondary outcomes are: (1) cost-effectiveness and willingness to pay; (2) patient-reported outcome measures (PROMS) questionnaires on the experiences of the participants; and (3) the maternal and perinatal outcomes according to the type of antihypertensive medication. Demographic, and maternal and neonatal outcomes are collected from the patients’ electronic records. Blood pressure and compliance rate will be obtained from an online digital coordination platform for remote data handling. Information about the healthcare-related costs will be obtained from the National Coordination Committee of Belgian Health Insurance Companies (Intermutualistisch Agentschap). PROMS will be assessed using validated questionnaires. Discussion To our knowledge, this is the first randomized trial comparing midwife-assisted RM and self-monitoring of prenatal blood pressure versus conventional management among women at increased risk of GHD. Positive results of this study may lead to a practical framework for caregivers, hospital management, and payers to introduce RM into the prenatal care programs of high-risk pregnancies. Trial registration This study was registered on clinicaltrials.gov, identification number NCT04031430. Registered 24 July 2019, https://clinicaltrials.gov/ct2/show/NCT04031430?cond=premom+ii&draw=2&rank=1.

Self-monitoring Blood Glucose (SMBG): Now and the Future

2004 ◽  
Vol 17 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Amber L. Briggs ◽  
Susan Cornell
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Microvascular Complications ◽  
Blood Glucose Control ◽  
Glucose Monitoring ◽  
The United States ◽  
Blood Glucose Monitoring ◽  
Self Monitoring ◽  
State Management ◽  
Monitoring Devices

In 2002, the cost of diabetes in the United States reached $132 billion. There is a well-established relationship between blood glucose control and the risk of diabetes-related complications. Tight blood glucose control, through intensive diabetes therapy, reduces the risk and delays the onset of diabetesrelated microvascular complications. Regular and consistent self-monitoring of blood glucose (SMBG) is and should be a part of all diabetes disease state management programs. Pharmacists can truly increase the numbers of patients who use SMBG by being aware and familiar with the monitoring devices available to patients and identifying the physical and psychological issues surrounding SMBG. Results from SMBG and hemoglobin A1C are the basis formost of the medical decisions made for patients with diabetes. This review discusses the best time for patients to test their blood glucose, information regarding blood glucose monitoring devices, alternative site testing, and the newest technology available in glucose monitoring.

scholarly journals Integration and Adoption Analysis of Digital Health Monitoring Devices: Reflections of a Pilot Project (Preprint)

2018 ◽  
Author(s):  
Christopher Park ◽  
Emmamuzo Otobo ◽  
Jason Rogers ◽  
Farah Fasihuddin ◽  
Shashank Garg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Monitoring System ◽  
Remote Monitoring ◽  
Hospital Readmissions ◽  
Smart Devices ◽  
Remote Monitoring System ◽  
Factors Associated ◽  
Digital Medicine ◽  
Monitoring Devices

BACKGROUND Congestive heart failure (CHF) is a disease that affects about 6.5 million people in the United States with a mortality rate of around 30%. With the incidence rate projected to rise by 46% to exceed 8 million cases by 2030, projections estimate that total CHF costs will increase about to nearly $70 billion. Recently, the advent of remote monitoring technology has significantly broadened the scope of the physician’s reach in chronic disease management. Using remotely monitored health data, providers may be able to better manage and predict their patients’ outcomes, leading to reduced incidence and hospital admission costs. OBJECTIVE This project aimed to demonstrate the feasibility of a digital medicine engagement platform for CHF patients, including identifying factors associated with increased risk of readmission and assessing usage patterns of remote monitoring devices. METHODS The project included 60 patients admitted to Mount Sinai Hospital for CHF. A digital medicine platform by Rx.Health, called RxUniverse, was used to prescribe HealthPROMISE and iHealth mobile apps. Patients updated and recorded their CHF-related symptoms and quality of life measures daily on HealthPROMISE. Vital sign data, including blood pressure and weight, were collected through an ambulatory remote monitoring system that integrated the iHealth app and complementary consumer grade Bluetooth-connected smart devices (blood pressure cuff and digital scale). Physicians were notified of abnormal patient blood pressure and weight change readings and further action was left to the physician’s discretion. We used statistical analyses to determine risk factors associated with 30-day all-cause readmission. RESULTS Overall, there were six 30-day hospital readmissions (10%), compared to the national readmission rates of around 25%. Single marital status (P<.1) and history of percutaneous coronary intervention (P<.1) were associated with readmission. Readmitted patients were also less likely to have been previously prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (P<.05). Notably, readmitted patients utilized the blood pressure and weight monitors less than non-readmitted patients, and patients aged less than 70 used the monitors more frequently on average than those over 70, though these trends did not reach statistical significance. The percentage of patients using the monitors at least once dropped steadily from 83% in the first week after discharge to 46% in the fourth week. Additionally, 88% of patients used the monitor at least 4 times and 62% at least 10 times, with some patients using the monitors multiple times per day. CONCLUSIONS Given the increasing burden of CHF, there is a need for an effective and sustainable remote monitoring system for CHF patients following hospital discharge. We identified clinical and social factors as well as remote monitor usage trends that identify targetable patient populations that could benefit most from integration of daily remote monitoring. In addition, we demonstrated that interventions driven by real-time vitals data may greatly aid in reducing hospital readmissions and costs while improving patient outcomes. Future studies should seek to implement remote monitoring and confirm usage trends as well as risk factors in a large-scale population.

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

2020 ◽  
Vol 10 (3) ◽  
pp. 198-208 ◽  
Author(s):  
Hasan Haci Yeter ◽  
Omer Faruk Akcay ◽  
Claudio Ronco ◽  
Ulver Derici
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Treatment Adherence ◽  
Remote Monitoring ◽  
Pressure Control ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients’ compliance with treatment and, thus, clinical outcomes. Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program. Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up. Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500–1,000] and 752 mL [490–986] vs. 824 mL [537–1,183]). The daily antihypertensive pill need (4 [0–7] vs. 2 [0–6]) and alarms received from the device decreased (from 4 [3–8] to 2 [0–3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

scholarly journals Recruiting Student Health Coaches to Improve Digital Blood Pressure Management: Randomized Controlled Pilot Study

10.2196/13637 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e13637
Author(s):  
Elena Vasti ◽  
Mark J Pletcher
Keyword(s):  
High School ◽  
Blood Pressure ◽  
High School Students ◽  
Pilot Study ◽  
The United States ◽  
Student Health ◽  
Health Coach ◽  
School Students ◽  
Self Monitoring ◽  
Health Coaches

Background Hypertension is a significant problem in the United States, affecting 1 in 3 adults aged above 18 years and is associated with a higher risk for cardiovascular disease and stroke. The prevalence of hypertension has increased in medically underserved areas (MUAs). Mobile health technologies, such as digital self-monitoring devices, have been shown to improve the management of chronic health conditions. However, patients from MUAs have reduced access to these devices because of limited resources and low health literacy. Health coaches and peer training programs are a potentially cost-effective solution for the shortage of physicians available to manage hypertension in MUAs. Activating young people as student health coaches (SHCs) is a promising strategy to improve community health. Objective This pilot study aims to assess (1) the feasibility of training high school students as health technology coaches in MUAs and (2) whether the addition of SHCs to digital home monitoring improves the frequency of self-monitoring and overall blood pressure (BP) control. Methods In total, 15 high school students completed 3-day health coach training. Patients who had a documented diagnosis of hypertension were randomly assigned to 1 of the 3 intervention arms. The QardioArm alone (Q) group was provided a QardioArm cuff only for convenience. The SHC alone (S) group was instructed to meet with a health coach for 30 min once a week for 5 weeks to create action plans for reducing BP. The student+QardioArm (S+Q) group received both interventions. Results Participants (n=27) were randomly assigned to 3 groups in a ratio of 9:9:9. All 15 students completed training, of which 40% (6/15) of students completed all the 5 meetings with their assigned patient. Barriers to feasibility included transportation and patient response drop-off at the end of the study. Overall, 92% (11/12) of the students rated their experience as very good or higher and 69% (9/13) reported that this experience made them more likely to go into the medical field. There was a statistically significant difference in the frequency of cuff use (S+Q vs Q groups: 37 vs 17; P<.001). Participants in the S+Q group reported better BP control after the intervention compared with the other groups. The average BP at the end of the intervention was 145/84 (SD 9/18) mm Hg, 150/85 (SD 18/12) mm Hg, and 128/69 (SD 20/14) mm Hg in the Q, S, and S+Q groups, respectively. Conclusions This pilot study demonstrates the feasibility of pairing technology with young student coaches, although challenges existed. The S+Q group used their cuff more than the Q group. Patients were more engaged in the S+Q group, reporting higher satisfaction with their SHC and better control of their BP.

scholarly journals Variation in Physician’s Recommendation of Blood Pressure Self-Monitoring in the United States: Results from Nhanes 2009 – 2014

2018 ◽  
Vol 21 ◽  
pp. S65
Author(s):  
CE Ozigbu ◽  
A Cofie ◽  
EE Haynes ◽  
V Kirksey ◽  
S Sriram ◽  
...  
Keyword(s):  
United States ◽  
Blood Pressure ◽  
The United States ◽  
Self Monitoring

Hypertension Knowledge and Willingness of Government Officials in a Southwestern Nigerian City to Self-Monitor Blood Pressure

2019 ◽  
Vol 40 (1) ◽  
pp. 39-46
Author(s):  
Moses A. Adebanjo ◽  
Mojisola M. Oluwasanu ◽  
Oyedunni S. Arulogun
Keyword(s):  
Blood Pressure ◽  
Tertiary Education ◽  
Educational Interventions ◽  
Questionnaire Data ◽  
Government Officials ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Self Monitoring ◽  
Hypertension Knowledge ◽  
Monitoring Devices

Self-monitoring of blood pressure (BP) is indispensable for the prevention and management of hypertension. Attitude and willingness to self-monitor BP have not been well investigated in Nigeria. This study investigated hypertension knowledge, attitude, and willingness of government officials in a southwestern Nigerian city to self-monitor BP. The study was a descriptive cross-sectional survey and 280 respondents completed a pretested, semistructured questionnaire. Data were analyzed using descriptive statistics and χ2 test. Mean age was 35.7 ± 10.6 years, 57.5% were women and 72.1% had tertiary education. Majority (65.7%) had poor knowledge about hypertension, only 1.8% recognized its symptomless nature. Majority (77.9%) had positive attitude toward being trained to self-monitor BP, while 82.1% were willing to buy self-monitoring devices. Hypertension knowledge was associated with age and marital status ( p < .05), while attitude was associated with willingness to self-monitor BP ( p < .05). Population-wide, educational interventions should be intensified to improve hypertension knowledge and enhance skills to self-monitor BP.

scholarly journals Achieving Rapid Blood Pressure Control With Digital Therapeutics: Retrospective Cohort and Machine Learning Study (Preprint)

2018 ◽  
Author(s):  
Nicole L Guthrie ◽  
Mark A Berman ◽  
Katherine L Edwards ◽  
Kevin J Appelbaum ◽  
Sourav Dey ◽  
...  
Keyword(s):  
Machine Learning ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
The United States ◽  
Self Monitoring ◽  
Digital Intervention ◽  
Baseline Systolic Blood Pressure

BACKGROUND Behavioral therapies, such as electronic counseling and self-monitoring dispensed through mobile apps, have been shown to improve blood pressure, but the results vary and long-term engagement is a challenge. Machine learning is a rapidly advancing discipline that can be used to generate predictive and responsive models for the management and treatment of chronic conditions and shows potential for meaningfully improving outcomes. OBJECTIVE The objectives of this retrospective analysis were to examine the effect of a novel digital therapeutic on blood pressure in adults with hypertension and to explore the ability of machine learning to predict participant completion of the intervention. METHODS Participants with hypertension, who engaged with the digital intervention for at least 2 weeks and had paired blood pressure values, were identified from the intervention database. Participants were required to be ≥18 years old, reside in the United States, and own a smartphone. The digital intervention offers personalized behavior therapy, including goal setting, skill building, and self-monitoring. Participants reported blood pressure values at will, and changes were calculated using averages of baseline and final values for each participant. Machine learning was used to generate a model of participants who would complete the intervention. Random forest models were trained at days 1, 3, and 7 of the intervention, and the generalizability of the models was assessed using leave-one-out cross-validation. RESULTS The primary cohort comprised 172 participants with hypertension, having paired blood pressure values, who were engaged with the intervention. Of the total, 86.1% participants were women, the mean age was 55.0 years (95% CI 53.7-56.2), baseline systolic blood pressure was 138.9 mmHg (95% CI 136.6-141.3), and diastolic was 86.2 mmHg (95% CI 84.8-87.7). Mean change was –11.5 mmHg for systolic blood pressure and –5.9 mmHg for diastolic blood pressure over a mean of 62.6 days (P<.001). Among participants with stage 2 hypertension, mean change was –17.6 mmHg for systolic blood pressure and –8.8 mmHg for diastolic blood pressure. Changes in blood pressure remained significant in a mixed-effects model accounting for the baseline systolic blood pressure, age, gender, and body mass index (P<.001). A total of 43% of the participants tracking their blood pressure at 12 weeks achieved the 2017 American College of Cardiology/American Heart Association definition of blood pressure control. The 7-day predictive model for intervention completion was trained on 427 participants, and the area under the receiver operating characteristic curve was .78. CONCLUSIONS Reductions in blood pressure were observed in adults with hypertension who used the digital therapeutic. The degree of blood pressure reduction was clinically meaningful and achieved rapidly by a majority of the studied participants. Greater improvement was observed in participants with more severe hypertension at baseline. A successful proof of concept for using machine learning to predict intervention completion was presented.

scholarly journals Relationship between acculturation and blood pressure in Somali immigrants living in Minneapolis-St. Paul, Minnesota

2019 ◽  
Author(s):  
Ahmed Dalmar ◽  
Brian C. Martinson ◽  
Morgan Brown ◽  
Maharaj Singh ◽  
Douglas Pryce ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Multivariate Regression ◽  
Latent Class ◽  
The United States ◽  
Baseline Body Mass Index ◽  
Cardiovascular Risks ◽  
Somali Immigrants ◽  
Blood Pressures ◽  
The Relationship ◽  
Immigrant Acculturation

Abstract Background Immigrant acculturation to the United States has been found to correlate with cardiovascular risks. Little extant research has evaluated the relationship between acculturation and blood pressure in Somali immigrants. Methods We surveyed and measured blood pressures of 1156 Somali immigrants in Minneapolis-St. Paul, Minnesota. Latent class analysis identified four distinct acculturation subgroups. We examined the data for predictors of hypertension using generalized estimating equations. Results Our sample was majority female (62.4%), mean age 47.9 ± 18.4 years, mean baseline body mass index 30.2 ± 8.6 kg/m2 and mean years in U.S. of 9.9 ± 6.1. Multivariate regression showed that one acculturation group (low English, high trust) was less likely to be hypertensive. Conclusion We found no relationship between several measures of acculturation and hypertension. We found a difference between one of our acculturation groups and the others, suggesting a more complex relationship between acculturation and hypertension among Somali immigrants.

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