The Feasibility of a Web-based Application to Monitor Home Blood Pressure
| Status: | Active, not recruiting |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 50 - Any |
| Updated: | 11/28/2018 |
| Start Date: | May 16, 2017 |
| End Date: | October 2019 |
Control of hypertension remains one of the most important interventions available to
clinicians to reduce risk of cardiovascular disease, kidney disease and stroke. Self-measured
home blood pressure monitoring plus additional support has been shown to reduce blood
pressure in adults with previously uncontrolled hypertension. Most previous studies have
utilized healthcare personnel to facilitate communication of home blood pressure levels to
physicians and did not provide methods to directly transmit self-measured blood home blood
pressure levels to physicians via the electronic health record. Emerging technology now
provides the ability for patient's to upload self-measured blood pressure levels into their
own medical record which may eliminate the need for additional health personnel. This study
will examine the feasibility, patient adherence and physician and patient perceptions of a
web-based application which will facilitate direct input of self-measured home blood pressure
levels and patient reported symptoms directly into the electronic health record with message
alerts to the provider for hypertension management. Up to 10 Loyola primary care physicians
and 20 of their respective patients age 50 years and older who have a smart phone device or
home computer and have treated hypertension will be enrolled. The study will utilize the
existing web-application called MyChart. MyChart is the name of the web-based application and
it is not an acronym. Enrolled patients will download the existing MyChart web-based
application on their smart phone device or home computer and will record home blood pressure
measurements using their home blood pressure machine into their smart phone application. The
MyChart application is available to all patients receiving care in the Loyola Health Care
System. The blood pressure readings and patient reported symptoms will then be available for
their physicians to review within the electronic health record. After using the web-based
application for two months, both patients and physicians will be asked to participate in
focus groups and interviews, respectively, to determine their perceptions and satisfaction
with the web-based application. Data from this feasibility study may be used to guide a
future clinical trial of hypertension management that examines the effectiveness of the
MyChart web-based application for frequent blood pressure monitoring compared to standard
care.
clinicians to reduce risk of cardiovascular disease, kidney disease and stroke. Self-measured
home blood pressure monitoring plus additional support has been shown to reduce blood
pressure in adults with previously uncontrolled hypertension. Most previous studies have
utilized healthcare personnel to facilitate communication of home blood pressure levels to
physicians and did not provide methods to directly transmit self-measured blood home blood
pressure levels to physicians via the electronic health record. Emerging technology now
provides the ability for patient's to upload self-measured blood pressure levels into their
own medical record which may eliminate the need for additional health personnel. This study
will examine the feasibility, patient adherence and physician and patient perceptions of a
web-based application which will facilitate direct input of self-measured home blood pressure
levels and patient reported symptoms directly into the electronic health record with message
alerts to the provider for hypertension management. Up to 10 Loyola primary care physicians
and 20 of their respective patients age 50 years and older who have a smart phone device or
home computer and have treated hypertension will be enrolled. The study will utilize the
existing web-application called MyChart. MyChart is the name of the web-based application and
it is not an acronym. Enrolled patients will download the existing MyChart web-based
application on their smart phone device or home computer and will record home blood pressure
measurements using their home blood pressure machine into their smart phone application. The
MyChart application is available to all patients receiving care in the Loyola Health Care
System. The blood pressure readings and patient reported symptoms will then be available for
their physicians to review within the electronic health record. After using the web-based
application for two months, both patients and physicians will be asked to participate in
focus groups and interviews, respectively, to determine their perceptions and satisfaction
with the web-based application. Data from this feasibility study may be used to guide a
future clinical trial of hypertension management that examines the effectiveness of the
MyChart web-based application for frequent blood pressure monitoring compared to standard
care.
Observational studies and clinical trials have demonstrated that clinicians fail to intensify
therapy in hypertensive management despite patients not meeting goal. For this reason,
patient centered tools can help facilitate meeting goals with the provider. Web-based
communication combined with provider care management successfully lowered blood pressure to
<140/90 mm Hg in prior studies of patients with hypertension. Emerging technology now
provides the ability for patients to upload self-measured home blood pressure information
into their own medical record which may eliminate the need for additional health personnel.
This study will investigate the feasibility of health informatics to facilitate better
compliance and safety for both provider and patient for hypertension management. The home
blood pressure readings along with patient reported symptoms will be recorded using the
MyChart, a web-based tool available to all patients receiving care at Loyola University
Medical Center. MyChart can be accessed with a hand-held device or home computer. After
enrollment, patients will receive a notice every two weeks via MyChart to upload home blood
pressure values and patient reported symptoms. This information entered into MyChart by
patients will be placed into the electronic health record in a home vital signs flow sheet,
which will be separate from the flow sheet of vital signs measured in the clinic. Physicians
will receive an alert message when patients upload the blood pressure data. The alert message
will provide physicians with the average blood pressure value over the two weeks and will
provide simple guidance on whether actions, such as titrating existing medication should be
taken (based on whether BP is ≥ 140/90 mmHg). Patients will also be able to track their own
home blood pressure values using the MyChart application. As a first step, we are first
examining the feasibility of this web-based application and determining the perceptions of
both patients and physicians.
therapy in hypertensive management despite patients not meeting goal. For this reason,
patient centered tools can help facilitate meeting goals with the provider. Web-based
communication combined with provider care management successfully lowered blood pressure to
<140/90 mm Hg in prior studies of patients with hypertension. Emerging technology now
provides the ability for patients to upload self-measured home blood pressure information
into their own medical record which may eliminate the need for additional health personnel.
This study will investigate the feasibility of health informatics to facilitate better
compliance and safety for both provider and patient for hypertension management. The home
blood pressure readings along with patient reported symptoms will be recorded using the
MyChart, a web-based tool available to all patients receiving care at Loyola University
Medical Center. MyChart can be accessed with a hand-held device or home computer. After
enrollment, patients will receive a notice every two weeks via MyChart to upload home blood
pressure values and patient reported symptoms. This information entered into MyChart by
patients will be placed into the electronic health record in a home vital signs flow sheet,
which will be separate from the flow sheet of vital signs measured in the clinic. Physicians
will receive an alert message when patients upload the blood pressure data. The alert message
will provide physicians with the average blood pressure value over the two weeks and will
provide simple guidance on whether actions, such as titrating existing medication should be
taken (based on whether BP is ≥ 140/90 mmHg). Patients will also be able to track their own
home blood pressure values using the MyChart application. As a first step, we are first
examining the feasibility of this web-based application and determining the perceptions of
both patients and physicians.
- Inclusion Criteria:
- Willing to participate in all study procedures
- Potential subject owns a personal device and is able to run the web-application
- Physician directed blood pressure goal is < 140/90 mmHg
- Exclusion Criteria:
- No use of blood pressure lowering medications
- Arm circumference too large or small to allow accurate blood pressure measurement
- A medical condition likely to limit survival to less than 6 months, or a cancer
diagnosed and treated within the past two years that, in the judgment of clinical
study staff, would compromise a participant's ability to complete the study
- Inability to give informed consent
- History of systolic heart failure (ejection fraction < 35%)
- History of stroke
- History of proteinuria ≥ 1 gram in a 24 hour urine collection or a random urine
albumin/creatinine ratio ≥ 300 mg/g or a random urine protein/creatinine ratio ≥
300 mg/g
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