Managed Care - November 2008 - (Page 36)

Until now, however, there have been no clear guidelines about how patients should monitor themselves — or how physicians could use the patient-generated information to help make treatment decisions. “Patients come in with an index card, and it will have a haphazard number of readings they’ve taken in the last six months. It’s different dates and different times — you can’t make heads or tails of it,” says William B. White, MD, professor in the University of Connecticut school of medicine’s division of hypertension and clinical pharmacology. “You have no idea what to do with that information.” Should plans cover? Thomas G. Pickering, MD, knows it will take years — maybe decades — for home monitoring to become the norm. One barrier to quick adoption is loss of physician income. “Physicians who get paid per visit may not welcome this even though we think it is much more efficient and economical if you look at the whole picture,” says Pickering, director of the Center for Behavioral Cardiovascular Health at Columbia Presbyterian Medical Center in New York. Physicians will get on board most rapidly when they are paid to train patients to use their home monitoring devices properly, to assess patients’ athome readings, and to adjust medications by communicating with their patients by way of phone or Internet connection. Developing those payment codes is likely to require understanding the cost-effectiveness of home monitoring, and research into that has not yet been conducted. Aetna, for example, does not pay for blood pressure cuffs. Nor does it pay physicians for activities in support of monitoring at home. (Aetna does cover blood pressure monitors and stethoscopes How home monitoring beats office BP measurement rather counterintuitive fact — that patients can get more accurate blood pressure readings than their physicians — comes from research that shows two things: A * Between 10 percent and 20 percent of people diagnosed with high blood pressure in a physician’s office actually have white-coat effect. Their pressures are normal under other conditions, but rise in a medical setting. * Another sizable portion of the population has masked hypertension, the reverse of white-coat effect. Those patients have normal readings in a physician’s office but high blood pressure under other circumstances. About 10 percent of the general population is believed to have masked hypertension, and some patients who appear to control their hypertension with treatment are also believed to have unreliable readings in their physician’s office. Blood pressure experts consider a patient’s “true” blood pressure to be the average level over a period, and the best way to measure it is with an automated recorder over 24 hours, an expensive and cumbersome procedure that is not realistic for the population at large. In a scientific statement published online in Hypertension: Journal of the American Heart Association, the Journal of the American Society of Hypertension and the Journal of Clinical Hypertension and printed in the June 2008 issue of Journal of Cardiovascular Nursing, scientists say home monitoring is the next best thing. Because blood pressure varies considerably during the day, taking one reading at a physician’s office every few months gives a point-intime datum that is unsatisfactory for deciding on treatment. By systematically monitoring blood pressure — at least two readings in the morning and two readings in the evening every day for one week each quarter — patients can provide their physicians with a better understanding of their true blood pressure level. Home monitoring is particularly useful in the elderly as well as in patients with diabetes, patients with kidney disease, and pregnant women, according to the new guidelines. 36 MANAGED CARE / NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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