Remote Monitoring Improves Hypertension Outcomes

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Remote patient monitoring (RPM) can improve the outcomes of anti-hypertensive therapy in older adults, with some accompanying increases in costs, reports a study in Annals of Internal Medicine.

The researchers identified matched groups of traditional Medicare beneficiaries receiving treatment for hypertension at practices with high use of RPM (≥25% of patients) or low RPM use (<2.5% of patients). The analysis included 19,978 patients at 192 high-use RPM practices and 95,029 patients at 942 low-use RPM practices. Measures of anti-hypertensive medication use were compared, along with outpatient visits, use of tests and imaging, and hypertension-related spending.

Several measures of anti-hypertensive medication use were significantly improved in the high-use RPM group. Findings included relative increases of 3.3% in medication fills, 1.6% in days with medication supply, and 1.3% in unique medications prescribed. Hypertension-related acute care encounters decreased by 9.3% with high RPM use, whereas testing and imaging use decreased by 5.9%. Most of the reduction in testing was related to clinical chemistry tests. Patients treated at high-use RPM practices had a relative 7.2% increase in primary care office visits, with a $45 increase in spending, largely driven by increased use of telemedicine. The total increase in spending in the high-use RPM group was $274 per patient, for a relative increase of 7.4%.

In subgroup analyses, patients with low initial medication adherence had greater improvements in hypertension-related acute care visits and hospitalizations. These effects included not only emergency department visits but also hospitalizations for stroke and cardiovascular disease.

The authors define RPM as “remote transmission of physiologic measurements from patients to clinicians.” Although the use of RPM for chronic disease management is growing rapidly, there are concerns that it may lead to increased spending without meaningful improvements in care.

The new study, designed to emulate a longitudinal cluster randomized trial, shows increased anti-hypertensive medication use for Medicare patients at high-use RPM practices. This and other improvements suggest “a more aggressive approach to hypertension control” at practices that use RPM. The findings also show “overall increased spending from direct RPM reimbursement and incremental PCP [primary care physician] visits,” the researchers write. They discuss possible approaches to increase the value of RPM for patients with hypertension [Tang M, et al. Effects of remote patient monitoring use on care outcomes among Medicare patients with hypertension: An observational study. Ann Intern Med 2023; 176:1465–1475. doi: 10.7326/M23-1182].