A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth.

CONTEXT: Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES: To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN: A prospective case series study. SETTING: Five FQHCs. PARTICIPANTS: The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION: SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE: Systolic blood pressure and diastolic blood pressure. RESULTS: Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS: Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.

Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic.

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.

Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States.

BACKGROUND: Clinical guidelines increasingly recommended ambulatory blood pressure monitoring (ABPM) for hypertension diagnosis and management. Yet, ABPM is used infrequently in the United States, possibly because of low insurance coverage and high patient costs. We sought to analyze out-of-pocket payments (OPPs) for ABPM among privately insured patients. METHODS: We conducted a retrospective analysis using IBM® MarketScan® commercial claims of beneficiaries aged ≥18 years receiving ABPM from January 2012 to December 2018. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered the index date. Patients with 12 months of continuous enrollment preindex and 30-day postindex were included. Per beneficiary OPP was calculated by aggregating all ABPM-related OPPs within the 30-day postindex window (ABPM episode). RESULTS: Of 22,317 beneficiaries receiving ABPM, 62% had $0 OPP and 38% had OPP >$0. Among the latter, median OPP per beneficiary for an ABPM episode was $23 (interquartile range [IQR], $14, $32), driven primarily by full ABPM claims (median, $22; IQR, $14, $24). Among individual components, scan analysis and report claims (median, $25; IQR, $13, $49) had the greatest OPP. The median OPP per ABPM episode did not change substantively from 2012 through 2018. CONCLUSIONS: Among commercially insured in the United States, nearly 4-in-10 have an OPP for ABPM. Though most OPPs are relatively modest, some patients incur substantial OPP. Our findings highlight the need for policymakers to ensure adequate ABPM coverage in the commercial insurance marketplace.

The validity of a daytime ambulatory blood pressure to diagnose masked hypertension.

Masked hypertension (MH) is traditionally diagnosed with 24-hour ambulatory blood pressure monitoring (24-ABPM). This is relatively costly and could cause discomfort during the night. We studied the validity of daytime ABP (DT-ABPM) in young National Guard soldiers and determined the prevalence in comparison to the standard 24-ABPM. A prospective study of 196 soldiers aged 21-50 years, without a history of hypertension or antihypertensive medication use. Each participant was fitted with a 12h-ABPM. Patients were diagnosed with MH if the office blood pressure (OBP) was <140/90 mmHg and the average DT-ABPM was ≥135/85 mmHg. By pairing the average OBP with the 12 h-ABPM, the prevalence of MH was estimated as 18/196 (9.2%), the SBP MH (systolic blood pressure) of 8.2% and the DPB MH (diastolic blood pressure) of 3.1%.  When we compared the daytime prevalence with the 24 h-ABPM, and the average OBP, the prevalence of MH was 29/196 (14.8%). No statistically significant difference was noted (kappa=0.74; 95% CI: 0.59 to 0.88). We conclude that DT-ABPM is a good method and convenient to detect MH, with no statistically significant difference when compared to the 24 h-ABPM. The prevalence of MH in young healthy soldiers was unexpectedly high.

Medicare reimbursement policy for ambulatory blood pressure monitoring: A qualitative analysis of public comments to the Centers for Medicare and Medicaid Services.

Ambulatory blood pressure monitoring (ABPM) is considered the best means of diagnosing hypertension. However, it is rarely used and is reimbursed only under narrow conditions. We sought to gain insight into the perceived value of ABPM among stakeholders who responded to the Centers for Medicare and Medicaid Services' (CMS) request for comments to inform the first revision of ABPM reimbursement policy in over 15 years. We found that most comments were classifiable in two main themes, current coverage and future coverage. Individuals and institutions representing multiple disciplines and specialties were highly supportive of expanding the current CMS coverage of ABPM, including for a wide range of clinical indications and populations. It is clear from the comments reviewed that there is wide support for expanding CMS coverage for ABPM. Broad support for a change in ABPM reimbursement policy may lead to changes in the way this technology is used in the United States.

Assessment of the steps taken towards avoidance of medication errors among hypertensive outpatients attending a tertiary health care facility in Nigeria: a cross-sectional study.

INTRODUCTION: Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits. METHODS: A cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The IBM SPSS Version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant. RESULTS: A total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001). CONCLUSION: Patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.

A Faith-Based Intervention to Reduce Blood Pressure in Underserved Metropolitan New York Immigrant Communities.

Minority populations, including Asian Americans, face disparities in hypertension compared with non-Hispanic whites. This underscores the need for culturally adapted programs in settings that reach Asian American communities, such as faith-based organizations. We worked collaboratively with community partners to culturally adapt and implement an evidence-based community blood pressure monitoring program for Asian Americans (Asian Indians, Koreans, Filipinos, and Bangladeshis) in metropolitan New York during 2015 and 2016. The program included regularly scheduled volunteer-led screening and counseling events with congregants at faith-based organizations. Among participants with complete 6-month data (n = 348), health-related self-efficacy significantly improved after 6 months, and systolic and diastolic blood pressure was significantly reduced in some subgroups; reductions were highest in participants who self-reported a previous diagnosis of hypertension. Among Asian Americans, faith-based programs may be a replicable, low-cost, sustainable way to increase health-related self-efficacy and decrease blood pressure, specifically among individuals with self-reported hypertension.

Insights in Public Health: Ambulatory Blood Pressure Monitoring: Underuse in Clinical Practice in Hawai'i.

Hypertension is one of the leading causes of death and disability worldwide. Blood pressure reduction and control are associated with reduced risk of stroke and cardiovascular disease. To achieve optimal reduction and control, reliable and valid methods for blood pressure measurement are needed. Office based measurements can result in 'white coat' hypertension, which is when a patient's blood pressure in a clinical setting is higher than in other settings, or 'masked' hypertension, which occurs when a patient's blood pressure is normal in a clinical setting, but elevated outside the clinical setting. In 2015, the US Preventative Services Task Force recommended Ambulatory Blood Pressure Monitoring (ABPM) as the "best method" for measuring blood pressure, endorsing its use both for confirming the diagnosis of hypertension and for excluding 'white coat' hypertension. ABPM is a safe, painless and non-invasive test wherein patients wear a small digital blood pressure machine attached to a belt around their body and connected to a cuff around their upper arm that enables multiple automated blood pressure measurements at designated intervals (typically every 15 to 30 minutes) throughout the day and night for a specified period (eg, 24 hours). Patients can go about their typical daily activities wearing the device as much as possible, except when they are bathing, showering, or engaging in heavy exercise. Given the importance of blood pressure monitoring and control to population public health, this article provides details on the relevance and challenges of blood pressure measurement broadly then describes ABPM generally and specifically in the Hawai'i context.

Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network.

Hypertension represents a major burden in Asia, with a high prevalence rate but poor level of awareness and control reported in many countries in the region. Home blood pressure monitoring has been validated as an accurate and reliable measure of blood pressure that can help guide hypertension treatment as well as identify masked and white-coat hypertension. Despite its benefits, there has been limited research into home blood pressure monitoring in Asia. The authors reviewed the current evidence on home blood pressure monitoring in Asia, including but not limited to published literature, data presented at congresses, and national hypertension management guidelines to determine the current utilization of home blood pressure monitoring in clinical practice in the region. Public policies to enable greater access to home blood pressure monitoring and its use in clinical care would add considerably to improving hypertension outcomes in Asia.

Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.

In 2015, the US Preventive Services Task Force updated their hypertension recommendations to advise that adults with elevated office blood pressure (BP) undergo out-of-office BP measurement to exclude white coat hypertension before diagnosis. Our goal was to determine the most important barriers to primary care providers' ordering ambulatory and home BP monitoring in the United States. We enrolled 63 primary care providers into nominal group panels in which participants iteratively listed and ranked barriers to ambulatory and home BP monitoring. Top-ranked barriers to ambulatory BP monitoring were challenges in accessing testing, costs of testing, concerns about the willingness or ability of patients to successfully complete tests, and concerns about the accuracy and benefits of testing. Top-ranked barriers to home BP monitoring were concerns about compliance with the correct test protocol, accuracy of tests results, out-of-pocket costs of home BP devices, and time needed to instruct patients on home BP monitoring protocol. Efforts to increase the use of ambulatory and home BP monitoring by primary care providers in the United States should prioritize increasing the financial and personnel resources available for testing and addressing provider concerns about patients' ability to conduct high-quality tests.

A cross-sectional study of the prevalence, awareness, treatment and control of hypertension in Shenzhen, China.

OBJECTIVES: An understanding of the awareness, treatment and control of hypertension is helpful to guide decision-making regarding interventions to reduce the risk for diseases with hypertension as a key risk factor. This study aimed to estimate the prevalence, awareness, treatment, and control of hypertension in Shenzhen, China. METHODS: A cross-sectional study was conducted. We employed multistage cluster random sampling methods to select participants. A survey involving face-to-face interviews was conducted to collect the data. A total of 1676 participants finished the survey and formed the final analysis. RESULTS: We found that the prevalence of hypertension was 17.6%. The rates of hypertension awareness, treatment and control were 48.8%, 51.4% and 43.2% respectively. Only 6.8% hypertensives were found to be managed by community health centres. Compared with the female participants, the males were found to have higher rates of prevalence (19.7% vs 15.7%; OR 1.47, 95% CI 1.10 to 1.97) and awareness (42.9% vs 38.1%; OR 2.35, 95% CI 1.28 to 4.33), but lower rates of medication treatments (20.5% vs 30.2%; OR 0.83, 95% CI 0.05 to 0.92) and control (12.8% vs 23.0%; OR 0.45, 95% CI 0.21 to 0.96). Migrants were more likely to be aware of hypertension (32.5% vs 44.3%; OR 0.57, 95% CI 0.30 to 0.90), reduce their salt intake (8.8% vs 18.1%; OR 0.40, 95% CI 0.15 to 0.94), and undertake regular monitoring of hypertension (1.3% vs 11.0%; OR 0.14, 95% CI 0.02 to 0.92) when compared with the locals. CONCLUSIONS: Our study finds that hypertension is an important public health burden in Shenzhen. It implies that strategies need to be developed to improve effective primary care management of hypertension. It also suggests a need to develop gender and household register tailored strategies for the prevention, detection, treatment and control of hypertension.

Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents.

Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%-30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.

Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012.

Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk.

[Outpatient blood pressure monitoring is not always necessary]. / La monitorización ambulatoria de la presión arterial no siempre es necesaria.

It is clear that clinical measurements of blood pressure can lead to errors in the diagnostic process and follow-up of patients with hypertension. Scientific societies recommend other measurement methods, such as home measurements and outpatient monitoring. Outpatient monitoring might be the golden standard but, nowadays has an important limitation-its availability. Home measurements solve 80-90% of the doubts of the diagnostic process and follow-up of patients with hypertension, and its higher availability and acceptance by the patient are clear. Home measurements should be used in the diagnostic process of arterial hypertension as a screening test for white coat hypertension and masked hypertension. They should be used as a screening test for resistant hypertension in the follow-up of patients with high blood pressure. Besides, in the follow-up of patients with hypertension home measurements have shown that they can contribute to treatment adherence, reduce clinical inertia and make data teletransmission possible, aspects that have proven to help improve the degree of control of hypertensive patients. Therefore, home measurements would be the treatment of choice for the diagnosis and follow-up of most patients with hypertension. We should consider home measurements and outpatient monitoring as complementary methods for the diagnosis and follow-up of patients with high blood pressure.

[Implantable sensors for outpatient assessment of ventricular filling pressure in advanced heart failure : Which telemonitoring design is optimal?] / Implantierbare Sensoren zur ambulanten Beurteilung des ventrikulären Füllungsdrucks bei fortgeschrittener Herzinsuffizienz : Welches Telemonitoring-Design ist optimal?

INTRODUCTION: Patients with advanced heart failure suffer from frequent hospitalizations. Non-invasive hemodynamic telemonitoring for assessment of ventricular filling pressure has been shown to reduce hospitalizations. We report on the right ventricular (RVP), the pulmonary artery (PAP) and the left atrial pressure (LAP) sensor for non-invasive assessment of the ventricular filling pressure. METHODS: A literature search concerning the available implantable pressure sensors for noninvasive haemodynamic telemonitoring in patients with advanced heart failure was performed. RESULTS: Until now, only implantation of the PAP-sensor was able to reduce hospitalizations for cardiac decompensation and to improve quality of life. The right ventricular pressure sensor missed the primary endpoint of a significant reduction of hospitalizations, clinical data using the left atrial pressure sensor are still pending. CONCLUSION: The implantation of a pressure sensor for assessment of pulmonary artery filling pressure is suitable for reducing hospitalizations for heart failure and for improving quality of life in patients with advanced heart failure.

Previous blood pressure measurement and associated factors in student adolescents.

OBJECTIVE: To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents. METHODS: This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis. RESULTS: Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician's office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97). CONCLUSION: Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured.

Impact of ambulatory blood pressure monitoring on the diagnosis of hypertension in children.

Screening of hypertension in children commonly starts with office measurement of the blood pressure according to the Fourth Report. The latter however does not account for masked hypertension (MH) on the one hand and white coat hypertension (WCH) on the other. We aimed to investigate in a single large pediatric population how much the addition of ambulatory blood pressure monitoring (ABPM) helps to refine the allocation to the different classes of blood pressure. In a retrospective study, we reclassified the records of a cohort of 500 children, who attended our department for investigation of possible hypertension, according to the Fourth Report and the revised ABPM interpretation scheme. As expected, ABPM interpretation scheme detected MH and WCH; however, 14% of children evaluated according to this scheme did not fit in any categories. On the other hand, applying the Fourth Report criteria, 80% of prehypertensive children ended up in the uncategorized or the MH groups. Our data confirm that ABPM detects the cases of MH and WCH, and minimizes the misplacement of prehypertensive children; unfortunately however, it also leaves a significant number of patients remain unclassified.

Previous blood pressure measurement and associated factors in student adolescents / Medida prévia da pressão arterial e fatores associados em adolescentes estudantes

Objective To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents.Methods This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis.Results Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician’s office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97).Conclusion Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured.

Objetivo Identificar a prevalência de medida prévia da pressão arterial no último ano e analisar alguns fatores associados a essa medida em adolescentes estudantes.Métodos Estudo transversal realizado com 6.077 adolescentes entre 14 e 19 anos. Foram coletados os dados demográficos (sexo, faixa etária, turno de estudo, região de residência, trabalho, cor da pele e situação econômica) e históricos da medida da pressão arterial nos últimos 12 meses, além do local em que essa medida foi realizada e o valor de pressão arterial. Foi utilizada análise descritiva e de regressão logística para avaliar as associações entre a medida prévia da pressão arterial e os dados demográficos e a pressão arterial elevada.Resultados No presente estudo, 56,8% responderam não ter medido a pressão arterial nos últimos 12 meses. O posto de saúde e a consulta médica foram os lugares mais mencionados (28,3% e 36,9%, respectivamente) em que foi realizada a medida da pressão arterial. Ser do sexo masculino (odds ratio de 1,64; IC95%: 1,46-1,84), ter idade entre 14 e 16 anos (odds ratio de 1,12; IC95%:1,01-1,25) e apresentar situação econômica desfavorável (odds ratio de 1,48; IC95%: 1,32-1,67) foram associados positivamente a não medição da pressão arterial. Trabalhar foi fator de proteção para não medição da pressão arterial (odds ratio de 0,84; IC95%: 0,73-0,97).Conclusão Elevado número de adolescentes não mediu pressão arterial nos últimos 12 meses. Rapazes, adolescentes com idade entre 14 e 16 anos e com situação econômica desfavorável apresentaram maior chance de não medir a pressão arterial.

Evidence-based Heuristics for Evaluating Demands on eHealth Literacy and Usability in a Mobile Consumer Health Application.

Heuristic evaluations have proven to be valuable for identifying usability issues in systems. Commonly used sets of heuritics exist; however, they may not always be the most suitable, given the specific goal of the analysis. One such example is seeking to evaluate the demands on eHealth literacy and usability of consumer health information systems. In this study, eight essential heuristics and three optional heuristics subsumed from the evidence on eHealth/health literacy and usability were tested for their utility in assessing a mobile blood pressure tracking application (app). This evaluation revealed a variety of ways the design of the app could both benefit and impede users with limited eHealth literacy. This study demonstrated the utility of a low-cost, single evaluation approach for identifying both eHealth literacy and usability issues based on existing evidence in the literature.