Journal Highlights & News
Web-based pharmacy care: a new model improves BP control
1 August 2008 - USA investigators report on JAMA that patients with hypertension show significant improvements in blood pressure (BP) control after undergoing a pharmacist-care, web-communication, home-monitoring program.
Beverly B Green, MD (Group Health Center for Health Studies, Seattle, Washington, USA) and colleagues examined whether a new model of care using patient web services, home BP monitoring, and pharmacist-assisted care improved BP control. They randomly assigned 778 patients in 3 groups, aged 25 to 75 years, with uncontrolled essential hypertension to usual care, home BP monitoring and secure patient website training only, or to home BP monitoring and secure patient website training plus pharmacist care management delivered through web communications (Table 1). Of the participants, 730 (94%) completed the 1-year follow-up visit.
Table. Baseline characteristics of patients in the Electronic Communications and Home Blood Pressure Monitoring Trial
Patients assigned to home BP monitoring and web training only were more likely to achieve BP control than those receiving usual care, at 36% versus 31%, but this difference did not reach statistical significance. Patients in the home BP monitoring and website training plus pharmacist care group were significantly more likely to achieve BP control than those in the usual care and home BP monitoring plus web-training only groups, at 56% versus 31% and 36%, respectively (p<0.001).
Systolic BP (SBP) decreased significantly in both the home BP monitoring and web training plus pharmacist care and web training only groups compared with usual care, with a mean difference of 8.9 and 6.0 mmHg, respectively (p<0.001). Diastolic BP (DBP) decreased only in the pharmacist care group, with a mean difference of 3.5 mmHg (p<0.001).
Furthermore, in the subgroup of patients with baseline SBP of 160 mmHg or higher, those who received home BP monitoring and web training plus pharmacist care had a greater mean reduction in SBP (13.2 mmHg, p<0.001) and DBP (4.6 mmHg, p<0.001) than patients who received usual care. They were 3.3-times more likely to achieve BP control than their counterparts who received usual care (p<0.001).
The researchers conclude: “Our findings demonstrate the effectiveness of using home BP monitoring combined with pharmacy care over the web to improve BP control for patients with essential hypertension… More studies are needed to determine whether similar care can be applied to other chronic diseases, be implemented in other settings, and decrease costs.”
Daniel Jones, MD (University of Mississippi Medical Center, Jackson, USA) and Eric Peterson, MD (Duke Clinical Research Institute, Durham, USA) commented in an accompanying editorial: “By finding new tools, ensuring appropriate use by patients and clinicians, and integrating these systems into clinical practice, it will be possible to achieve more effective and cost-effective BP control, and ultimately to save lives.
