JMIR Publications

ABSTRACT

Background:

Almost 50% of U.S. adults have hypertension. While clinical trials indicate home blood pressure monitoring can be effective in managing hypertension, results might not materialize in practice due to patient adherence problems.

Objective:

To characterize Medicaid hypertensive patient adherence to daily telemonitoring, identify impacts of reminder adherence calls, and investigate associations with in-range biometrics.

Methods:

180 days of blood pressure and pulse data from a telemonitoring company were analyzed for mean transmission rate and mean percent transmissions in-range. The first 30 days of data were excluded due to startup effects. Protocols required patients to transmit readings by a specified time daily. Patients not transmitting got a reminder adherence call to troubleshoot problems and encourage transmission. Patients were partitioned into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 80% of days.

Results:

Mean patient age was 73.2 (SD 11.7), with 65.1% female, 80.2% urban, and 78.7% from south Texas (n=823). The adherent cohort (n=475, 57.7%) had a mean transmission rate of 74.9% before the adherence call and 91.3% after. The nonadherent cohort (n=348, 42.3%) had a mean transmission rate of 39.0% before and 58.0% after. From month 1 to month 5, transmission rates dropped by 1.9% and 10% for the adherent and nonadherent cohorts, respectively. Mean percent transmissions in-range was 60.9% and 53.9% for the adherent and nonadherent cohorts, with respective increases of 5.3% and 14.0% from month 1 to month 5.

Conclusions:

Although we found patients can achieve high levels of adherence, many experience adherence problems. While reminder adherence calls help, they may not be sufficient. Blood pressure control seems positively associated with adherence, although many nonadherent patients with telemonitoring exhibited improvement in the in-range metric.