Remote monitoring lowers blood pressure but adoption is low
October 2, 2024
Source: Fadlon, et al National Bureau of Economic Research, September. 2024
Researchers from UC San Diego published a preprint of results from a large academic medical center study of remote high blood pressure monitoring. Primary care physicians referred over 2500 with uncontrolled high blood pressure to a program that offered them a Bluetooth-enabled sphygmomanometer (BP cuff) that transmitted blood pressure readings electronically to a center where staff monitored them daily. Those who participated lowered their blood pressure and had decreased calculated cardiac risk.
The researchers also report that costs of those who participated were 40% lower than predicted costs, but I am skeptical of this result. Physicians might have referred patients who were more motivated, and the group of those treated was likely not comparable to the group which was used to create the prediction. Further, prevention of cardiovascular disease and decrease in medical costs would likely take far longer than 18 months. The paper does not disclose the cost of the intervention.
There are some additional cautionary notes. Enrollment in the program was only a bit over half of those referred (54%), and only half of those performed at least one blood pressure reading every two months. Those who were in minoritized groups (Black and Hispanic people) and those who live in underserved communities were still less likely to persist in the program. As a result, this type of a program could inadvertently exacerbate health disparities.
Patients whose referring physicians had higher net promoter scores (patient satisfaction) and patients with longer primary care relationships were more likely to complete enrollment.
Source: Fadlon, et al National Bureau of Economic Research, September. 2024
Implications for employers:
Remote monitoring can help members keep their blood pressure under control and can decrease cardiac risk.
Assessment of cost savings should include a matched control group and should consider the cost of the intervention.
Employers should track ongoing use of remote monitoring programs, as monitors sitting unused in member homes do not improve quality. Pay careful attention to when patients are removed from vendor programs with monthly fees.
This also demonstrates the importance of reporting by race and ethnicity to identify disparities and improve health equity.
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