Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries.
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Date
2012-10-15
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Abstract
OBJECTIVE Hypertension and other noncommunicable diseases represent a growing threat to low middle income countries LMICs Mobile health technologies may improve noncommunicable disease outcomes but LMICs lack resources to provide these services We evaluated the efficacy of a cloud computing model using automated self management calls plus home blood pressure BP monitoring as a strategy for improving systolic BPs SBPs and other outcomes of hypertensive patients in two LMICs SUBJECTS AND METHODS This was a randomized trial with a 6 week follow up Participants with high SBPs 140 mm Hg if nondiabetic and 130 mm Hg if diabetic were enrolled from clinics in Honduras and Mexico Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States plus a home BP monitor At baseline control patients received BP results hypertension information and usual healthcare The primary outcome SBP was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs Secondary outcomes included perceived health status and medication related problems RESULTS Of the 200 patients recruited 181 90 completed follow up and 117 of 181 had low literacy or high hypertension information needs The median annual income was 2 900 USD and average educational attainment was 6 5 years At follow up intervention patients SBPs decreased 4 2 mm Hg relative to controls 95 confidence interval 9 1 0 7 p 0 09 In the subgroup with high information needs intervention patients average SBPs decreased 8 8 mm Hg 14 2 3 4 p 0 002 Compared with controls intervention patients at follow up reported fewer depressive symptoms p 0 004 fewer medication problems pUnder0 0001 better general health pUnder0 0001 and greater satisfaction with care p 0 004 CONCLUSIONS Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient focused informatics support