Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial. Issue 12 (25th October 2022)

• Record Type: Journal Article
• Authors: Margolis, Karen L.; Bergdall, Anna R.; Crain, A. Lauren; JaKa, Meghan M.; Anderson, Jeffrey P.; Solberg, Leif I.; Sperl-Hillen, JoAnn; Beran, MarySue; Green, Beverly B.; Haugen, Patricia; Norton, Christine K.; Kodet, Amy J.; Sharma, Rashmi; Appana, Deepika; Trower, Nicole K.; Pawloski, Pamala A.; Rehrauer, Daniel J.; Simmons, Maria L.; McKinney, Zeke J.; Kottke, Thomas E.; Ziegenfuss, Jeanette Y.; Williams, Rae Ann; O'Connor, Patrick J.
• Is Part Of: Hypertension. Volume 79:Issue 12(2022)
• Page Start: 2708
• Page End: 2720
• Publication Date: 2022-10-25
• Subjects: blood pressure -- hypertension -- nurse practitioners -- patient-reported outcomes -- pharmacists -- physicians -- telemedicine; Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.122.19816
• Languages: English
• ISSNs: 0194-911X

Abstract

Abstract : Background: A team approach is one of the most effective ways to lower blood pressure (BP) in uncontrolled hypertension, but different models for organizing team-based care have not been compared directly. Methods: A pragmatic, cluster-randomized trial compared 2 interventions in adult patients with moderately severe hypertension (BP≥150/95 mm Hg): (1) clinic-based care using best practices and face-to-face visits with physicians and medical assistants; and (2) telehealth care using best practices and adding home BP telemonitoring with home-based care coordinated by a clinical pharmacist or nurse practitioner. The primary outcome was change in systolic BP over 12 months. Secondary outcomes were change in patient-reported outcomes over 6 months. Results: Participants (N=3071 in 21 primary care clinics) were on average 60 years old, 47% male, and 19% Black. Protocol-specified follow-up within 6 weeks was 32% in clinic-based care and 27% in telehealth care. BP decreased significantly during 12 months of follow-up in both groups, from 157/92 to 139/82 mm Hg in clinic-based care patients (adjusted mean difference −18/−10 mm Hg) and 157/91 to 139/81 mm Hg in telehealth care patients (adjusted mean difference −19/−10 mm Hg), with no significant difference in systolic BP change between groups (−0.8 mm Hg [95% CI, −2.84 to 1.32]). Telehealth care patients were significantly more likely than clinic-based care patients to report frequent home BP measurement, rate their BP care highly, and report that BP care visits were convenient. Conclusions: Telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02996565.