Home coaching ‘promising’ for hypertension primary care
MedWire News: Teaching patients with hypertension to monitor their blood pressure at home and having nonprofessional health coaches counsel them regularly on medication adherence can help them to control their blood pressure levels, suggests US research.
The study of 237 patients with poorly controlled hypertension showed that home blood pressure monitoring and weekly counseling from nonprofessional health coaches led to significant reductions in their systolic blood pressure levels after 6 months.
Participants also made fewer primary care visits in the 6 months during and after the intervention than they did in the 6 months before the study.
The investigators say these are innovations that "can improve care while saving physician time."
The study took place at a family medicine clinic in a public hospital serving low-income, largely minority patients. All patients had blood pressure levels of at least 145/90 mmHg and were assigned to undergo home blood pressure monitoring and weekly health coaching. Half the patients were also assigned to carry out in-home titration of their medications under the direction of the health coach.
The health coaches were nonlicensed health team members who received 16‑20 hours of training on hypertension and antihypertensive medications, as well as on lifestyle modifications including medication adherence counseling. They were situated in the clinic so they could easily interact with clinicians by email or in face-to-face discussions.
At the end of the 6-month study period, systolic blood pressure had fallen by a mean of 23.9 mmHg from baseline among in the home-titration arm, and by 19.3 mmHg among those in the no-home-titration arm. The 4.6 mmHg greater reduction with home-titration was not statistically significant.
For the whole group of patients, there was a mean 21.8 mmHg reduction as a result of blood pressure monitoring and coaching. In addition, the number of primary care office visits fell from 3.46 in the 6 months before the start of coaching to 2.55 during the 6 months of coaching; the mean number of visits was even lower, at 2.38, in the 6 months after the end of the intervention.
Commenting on the lack of a home-titration effect, Thomas Bodenheimer (University of California at San Francisco) and colleagues comment: "The feasibility of home-titration remains uncertain, as less than one-fifth of patients in that arm actually undertook an adjustment of their antihypertensive medication at home."
Writing in the Annals of Family Medicine, they note that the more health coach encounters patients had, the greater their reductions in blood pressure, suggesting that increasing the amount of coaching would offer even greater benefits.
In addition, they say their findings emphasize the important contribution that nonprofessional caregivers can make.
"The clinical outcomes achieved suggest that redesigning primary care for hypertension care does not require high-cost professionals," they conclude.
By Caroline Price