TELEMEDICINE IN HYPERTENSION

ABSTRACT

The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.