JMIR Publications

ABSTRACT

Background:

The ever-increasing burden of cardiovascular disease presents significant quality, cost and sustainability challenges in primary care. Novel digitally supported models of care may help address these challenges.

Objective:

The aim of this study sought to assess the comparative clinical and cost effectiveness of a novel, integrated community-based proactive digital care platform compared to usual models of care for managing hypertension in primary care in England.

Methods:

A retrospective pre-/post-implementation cohort study across eligible patients from 10 Primary Care Networks (PCNs) in England was performed. 4,895 patients utilising the digital care platform were retrospectively compared to that of 3,504 who had received usual care. The primary outcome was the achievement of HYP008 (<80 years, BP <140/90) and HYP009 (>80 years, BP <150/90mmHg) UK Quality and Outcomes Framework (QOF) indicators. Secondary outcomes assessed the effectiveness of BP control, patient engagement and hypothecated cost analyses. Sub-group analyses were performed for the CORE20 cohort - the most deprived 20% of the population. There were no significant differences in sex, deprivation decile or ethnicity between the two cohorts. The usual care cohort were slightly older in age (65.8yrs vs. 65.1yrs, p=<0.05) and contained a greater proportion of CORE20 patients (28.31% vs. 24.15%, p=<0.05).

Results:

Digitally cared for patients were 3.15 times more likely to achieve the HYP008 BP target (74.56% vs. 48.16%, OR 3.15; 95% CI 2.86 to 3.48), and 1.40 times more likely to achieve the HYP009 target (85.82% vs. 81.21%, OR 1.40; 95% CI 1.01 to 1.94). Mean time to blood pressure control was significantly shorter with digital care (16.1 days (0-309) vs. 92.8 days, (1-345), p=<0.05). The mean reduction in systolic BP did not differ between groups (-5.97mmHg vs. -5.74mmHg, p=0.56). There was significantly better patient engagement in the digital care cohort with 25.64 additional BP reading captured (29.11 vs. 3.47, p=<0.05) during the study period. The digital care platform was also cost saving compared to usual care, estimated to be in the order of £17.22 - £73.08 per patient per year.

Conclusions:

Novel integrated community-based proactive digital care platforms may deliver superior blood pressure control rates, more consistently and in shorter timeframes compared to usual care and may do so equitably. In addition to delivering better blood pressure control and addressing therapeutic inertia, it is highly likely to be cost-effective through generating substantial gains in incentivisation payments whilst delivering care at a reduced cost compared to usual models of care. Further implementation at scale will need to consider how the platform integrates with the management of other chronic health conditions and the impact it may have on the delivery of chronic disease management in other primary care settings and in diverse populations. Clinical Trial: N/A