Nurse phone calls enhance home BP telemonitoring for minority groups

Adding nurse care management to home telemonitoring reduced blood pressure (BP) more significantly among low-income Black and Hispanic stroke survivors than home telemonitoring alone, according to new research.

Published in the Journal of the American Medical Association (JAMA), the study aimed to determine the efficacy of home-based BP telemonitoring and nurse case management via the telephone in helping low-income racial minority groups manage uncontrolled hypertension following a stroke.

Black populations face a higher risk of stroke than their White counterparts. According to data from the US Department of Health and Human Services (HHS) Office of Minority Health (OMH), Black people are 50 percent more likely to have a stroke and 70 percent more likely to die from a stroke as compared to their white peers.

While Hispanic and White adults have similar rates of strokes and stroke-related deaths, there are disparities in the care they receive, HHS OMH data shows.

With high BP being a major risk factor for stroke, researchers from New York, Texas, and Maryland conducted a randomized clinical trial to determine whether nurse case management can enhance home BP telemonitoring outcomes for low-income Black and Hispanic stroke survivors with uncontrolled hypertension. They enrolled 450 study participants between April 18, 2014, and December 19, 2017, of which 226 were randomly assigned to receive home BP telemonitoring alone and 224 home BP telemonitoring and nurse care management. The participants had a final follow-up visit on December 31, 2019.

Home BP telemonitoring involved participants taking their blood pressure 12 times weekly for one year. Readings were wirelessly transmitted to a web-based portal, and monthly reports were sent to healthcare providers. Irregular readings prompted a phone call from a clinician. Home BP telemonitoring with nurse care management included 20 telephone counseling calls from nurse case managers over the year in addition to home telemonitoring.

Of the 450 participants enrolled, 358 (80 percent) completed the trial. Researchers found that at 12 months, those who received counseling calls from nurses in addition to home telemonitoring had a significantly greater reduction in systolic BP than those who only received home telemonitoring. Patients in the former group experienced a two-and-a-half times greater decline in systolic BP than those in the latter group.

“We found that low-income Black and Hispanic patients with stroke and significant comorbidity benefit greatly from telemedicine in general, which we know ramped up during the COVID-19 pandemic,” said study lead author Olugbenga G. Ogedegbe, MD, MPH, director of the Institute for Excellence in Health Equity and professor in the population health and medicine departments at NYU Grossman School of Medicine, in a press release. “The benefit of home blood pressure telemonitoring was even more profound with the addition of nurse case management.”

However, the rate of recurrent stroke was similar between both groups at two years, with nine patients in each group having another stroke. Ogedegbe noted that more research is required to determine the long-term clinical outcomes, cost-effectiveness, and generalizability of nurse case management in remote monitoring programs, according to the press release.

While data on nurse case management in remote monitoring programs is sparse, recent research has shown that using remote patient monitoring (RPM) to care for hypertension patients increased outpatient visits and net healthcare spending.

The study, published in 2023, examined traditional Medicare claims for patients with a hypertension diagnosis in 2019. Each patient was assigned to a clinical practice that accounted for most of their 2019 primary care service spending.

The researchers categorized the practices based on the share of the patients who received RPM in 2020, defining practices where 25 percent or more hypertension patients received RPM as “high-RPM practices” and those where less than 2.5 percent of hypertension patients received RPM as “low-RPM practices.”

The study shows that high-RPM practices experienced a relative increase of $274 per patient in net hypertension-related spending. Patients at these practices also had more primary care provider (PCP) office visits than their low-RPM practice counterparts.