Clinical impact of a tiered, pharmacist-driven remote patient monitoring protocol utilizing self-measured blood pressure readings

Abstract

Introduction: Pairing self-measured blood pressure (SMBP) with protocolized, non-physician follow-up consistently improves hypertension (HTN) management. However, these interventions are often resource-intensive and rely on a degree of technological proficiency that may exclude a vulnerable subset of the population. Objectives: The primary objective of this study was to determine the rate of attainment of blood pressure (BP) control (defined as <140/<90 mmHg) based on the most recent clinic-measured BP readings 12 months or more after enrollment in the Digital Care Monitoring program. The secondary objective was to determine if there was a difference between the most recent clinic-measured systolic and diastolic BP readings before enrollment compared with 12 months or more after the enrollment eligibility period. Methods: This study examined the impact of a tiered, non-physician SMBP program, engaging patients through a familiar communication medium to relay home BP readings. A pre-post quality improvement study was conducted in the outpatient arm of an integrated delivery network. Patients meeting selection criteria were invited to voluntarily enroll bi-monthly from October 2021 to July 2023. Patients consenting to enrollment received reminders twice weekly to respond with home BP readings, and an outreach protocol was established utilizing a medical assistant and clinical pharmacist. Results: The rate of attainment of BP control 12 months or more after the enrollment eligibility period was found to be 79.2% (p < 0.01). BP dropped significantly over the 12-month treatment course with a mean systolic BP difference of 19.97 mmHg (p < 0.001) and a mean diastolic BP difference of 12.34 mmHg (p < 0.001). Conclusion: The results indicate that a tiered, pharmacist-driven remote patient monitoring protocol utilizing SMBP readings is an effective management strategy to reduce BP in patients with uncontrolled HTN.