A TELECOMMUNICATIONS SYSTEM FOR MONITORING AND COUNSELING PATIENTS WITH HYPERTENSION - IMPACT ON MEDICATION ADHERENCE AND BLOOD-PRESSURE CONTROL

This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihyperte nsive medications and on blood pressure control. A randomized controll ed trial was conducted in 29 greater Boston communities. The study sub jects were 267 patients recruited from community sites who were greate r than or equal to 60 years of age, on antihypertensive medication, wi th a systolic blood pressure (SBP) of greater than or equal to 160 mm Hg and/or a diastolic blood pressure (DBP) of greater than or equal to 90 mm Hg. The study compared subjects who received usual medical care with those who used a computer-controlled telephone system in additio n to their usual medical care during a period of 6 months. Weekly, sub jects in the telephone group reported self-measured blood pressures, k nowledge and adherence to antihypertensive medication regimens, and me dication side-effects. This information was sent to their physicians r egularly. The main study outcome measures were change in antihypertens ive medication adherence, SBP and DBP during 6 months, satisfaction of patient users, perceived utility for physicians, and cost-effectivene ss. The mean age of the study population was 76.0 years; 77% were wome n; 11% were black. Mean antihypertensive medication adherence improved 17.7% for telephone system users and 11.7% for controls (P = .03). Me an DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls (P = .02). Among nonadherent subjects, mean DBP decreased 6.0 mm Hg fo r telephone users, but increased 2.8 mm Hg for controls (P = .01). For telephone system users, mean DBP decreased more if their medication a dherence improved (P = .03). The majority of telephone system users we re satisfied with the system. Most physicians integrated it into their practices. The system was cost-effective, especially for nonadherent patient users. Therefore, weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertensi on patients. This system can be used to monitor patients with hyperten sion or with other chronic diseases, and is likely to improve health o utcomes and reduce health services utilization and costs.