Digital Health Approaches for the Assessment and Optimisation of Hypertension Care Provision.

Although many aspects of our lives have been transformed by digital innovation, widespread adoption of digital health advancements within the health care sector in general, and for hypertension care specifically, has been limited. However, it is likely that, over the next decade, material increases in the uptake of digital health innovations for hypertension care delivery will be seen. In this narrative review, we summarise those innovations thought to have the greatest chance for impact in the next decade. These include provision of virtual care combined with home blood pressure (BP) telemonitoring, use of digital registries and protocolised care, leveraging continuous BP measurement to collect vast amounts of individual and population-based BP data, and adoption of digital therapeutics to provide low-cost scalable interventions for patients with or at risk for hypertension. Of these, home BP telemonitoring is likely the most ready for implementation, but it needs to be done in a way that enables efficient guideline-concordant care in a cost-effective manner. In addition, efforts must be focused on implementing digital health solutions in a manner that addresses the major challenges to digital adoption. This entails ensuring that innovations are accessible, usable, secure, validated, evidence based, cost-effective, and integrated into the electronic systems that are already used by patients or providers. Increasing the use of broader digital innovations such as artificial/augmented intelligence, data analytics, and interactive voice response is also critically important. The digital revolution holds substantial promise, but success will depend on the ability of collaborative stakeholders to adopt and implement innovative, usable solutions.

Cost-effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada.

Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost-effectiveness assessments are mixed. We examined the incremental cost-effectiveness of this intervention vs usual care in Canadians with cerebrovascular disease. A Markov decision model cost-utility analysis examining community-residing, high-risk patients with a recent nondisabling cerebrovascular event was created. A lifetime time horizon and health care payer perspective were used. Achieved BP, future cardiovascular risks, and attendant consequences on quality-adjusted life years and Canadian dollar costs were modeled. BP telemonitoring was assumed to occur for 3 months, then quarterly. Life tables were used to determine overall mortality, adjusted by cardiovascular disease mortality. Relative efficacies of intervention-associated BP lowering, resource use, and costs were obtained from Canadian published literature. Reduction in systolic BP of 9.7 mmHg was used in the base case; subsequently, robust sensitivity analyses were conducted. The results showed that, over the lifetime horizon, telemonitoring with case management led to net health care savings of $1929 Canadian and increased per-patient QALYs by 0.83. These findings were robust to sensitivity analysis, with the intervention remaining dominant or highly cost-effective. Increasing telemonitoring costs by 50% still resulted in the intervention being dominant; if the costs of telemonitoring plus case management were 2-3 times base case cost, incremental cost-effectiveness was $1200-$4700 per quality-adjusted life year gained. In conclusion, home BP telemonitoring and pharmacist case management poststroke lowered costs and improved QALYs. Strategies and funding for broad implementation of this dominant strategy should be implemented.

Home Blood Pressure Telemonitoring: Rationale for Use, Required Elements, and Barriers to Implementation in Canada.

Contemporary hypertension guidelines strongly endorse the use of home blood pressure (BP) monitoring for hypertension diagnosis and management. However, barriers exist that prevent optimal use of home BP measurements. Patients might not follow the recommended home BP measurement protocol, might not take the required number of readings, and/or might report only selected readings to their providers. Providers might not calculate the mean (used for clinical decision-making) and/or incorporate home BP measurements into the medical record. Use of home BP telemonitoring, defined as the process by which home BP readings are securely teletransmitted and summarized within a health care portal or electronic medical record for provider use, might overcome these barriers. Telemonitoring, especially when combined with protocolized case management, leads to statistically significant and clinically important BP reductions, and improvements in overall BP control. Despite evidence supporting its use, home BP telemonitoring is not widely used in Canada. Barriers to adoption can be classified as structural and financial. Although technological advancements have made telemonitoring highly feasible, infrastructure is lacking, and implementation remains a challenge; this is especially true with respect to creating simple and cost-effective systems that are user-friendly and acceptable to patients as well as to providers. Ensuring data security is crucial to successful implementation, as is developing appropriate reimbursement models for providers. If these barriers can be overcome, home BP telemonitoring has the potential to make care provision easier and more convenient for patients and providers, while improving BP control in Canadians with hypertension.