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Online tool helps control blood pressure long term

By Genevra Pittman

NEW YORK (Reuters Health) - In a new study, people with high blood pressure who could communicate with their pharmacists online had better blood pressure control a year after that service ended.

Previously researchers had found that patients randomly assigned to the web-based pharmacy care did better than those who used a patient website but had no extra help or were only trained to monitor their blood pressure at home.

The new findings suggest some of those benefits may hold up over the long run - even after patients stop messaging with their pharmacists, researchers said.

Hayden Bosworth, who studies treatment adherence at Duke University Medical Center in Durham, North Carolina, said there's been a lot of interest in how to help patients stick more closely to their blood pressure and cholesterol medications, for example.

"From a health care plan perspective, these interventions are expensive and we need to look more at the sustainability of the effects and look at it long term," said Bosworth, who wasn't involved in the new research.

"We need to look at it from a (return on investment) perspective."

The new study took place at Group Health, a Seattle-based health care system. Patients there already had online access to parts of their medical records and could email with their doctors through a secure website.

Researchers led by Dr. Beverly Green randomly assigned 778 people in the system with high blood pressure to one of three groups.

One group received usual care, a second was trained in how to monitor blood pressure at home and a third received the monitoring instruction and was able to communicate online with pharmacists.

A year after the intervention ended, 618 patients remained in the study. Blood pressure was controlled - meaning less than 140/90 milliliters of mercury (mm/Hg) - for 60 percent of people who had online access to pharmacists, compared to 48 to 52 percent of those in the other groups.

Average systolic blood pressure - the top number - was 134 in the pharmacy group versus 138 among usual care participants and 141 for the blood pressure monitoring only group. There was no difference between groups when it came to diastolic blood pressure, the study team reported in JAMA Internal Medicine.

"We thought that since the patients were used to taking care of their blood pressure and communicating with their pharmacists, now they would do that with their provider," Green told Reuters Health.

She said a formal cost analysis of the program is in the works, but that online pharmacist access cost about $400 per patient.

Given the improvement in blood pressure, "I believe it is very inexpensive," Green said.

But current reimbursement plans make it difficult to make these types of programs work, she said. For example, doctors typically don't get paid for communicating with patients online or over the phone - only in person.

Bosworth said online access to pharmacists is just one way to improve adherence to blood pressure medicines. Texts and emails from case managers are other strategies, he said.

"These kinds of interventions - patients are extremely satisfied with them," Green said.

"They really appreciate being able to get a hold of their provider when they need it. And they also like that they can get their questions answered when they need it and they don't have to come in," she added.

"I think we're at a point where we can do these self-management programs relatively well for at least med adherence," Bosworth told Reuters Health.

"The important part now is how do we take these, package them, and implement them in the real world?"

SOURCE: http://bit.ly/10lllFn JAMA Internal Medicine, online May 20, 2013.

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