ORIGINAL RESEARCH
David R Boston, MD, MS; Rose Gunn, MA; Shelby L Watkins, MPH; Rachel Gold, MPH, PhD; Suparna Navale, PhD; Laura Crocker, MSPH; Carmit McMullen, PhD
Corresponding Author: Carmit McMullen, PhD; Kaiser Permanente Center for Health Research
Email: Carmit.McMullen@kpchr.org
DOI: 10.3122/jabfm.2024.240456R1
Keywords: Blood Pressure, Disease Management, Electronic Health Records, Hypertension, Patient Monitoring, Smartphone, Telemedicine
Dates: Submitted: 12-16-2024; Revised: 03-31-2025; Accepted: 04-14-2025
Status: In production.
INTRODUCTION: Uncontrolled hypertension (blood pressure (BP) > 130/80) is the most prevalent reversible risk factor for cardiovascular disease. Remote patient monitoring (RPM) can be an effective way to improve BP control and was further incentivized by the COVID-19 pandemic, which necessitated remote chronic disease management. We report on a natural experiment involving federal funding for virtual care expansion, which included home BP kits (BP cuffs, smartphones, cellular data) to facilitate RPM.
METHODS: We performed a mixed methods analysis of 18 health centers that requested and received BP kits, assessing device distribution, patient use, and facilitators/barriers to RPM implementation. Electronic health record (EHR) data were investigated from 2020-2023. Qualitative data included semi-structured interviews with health center staff, patients, and programmatic staff and fieldnotes from observations of implementation meetings. Data were analyzed following a framework-informed thematic approach.
RESULTS: 10 of 18 health centers (56%) initiated RPM with ≥ 5 patients during the study period. A total of 1,748 patients had EHR orders to initiate RPM, of which 780 (45%) responded with any BP data and 271 (16%) with meaningful BP data. There was no correlation between RPM distribution/use and health center size or number of BP kits received. The biggest barriers to RPM uptake were inadequate health center resources and the complexity of operationalizing an RPM program in general and the BP kits specifically.
CONCLUSIONS: Supplying free RPM hardware and cellular data plans in the absence of adequate support resources is insufficient to successfully augment care among hypertensive patients at community-based health centers.