Managed Care - November 2008 - (Page 37)

Home monitoring plus pharmacist’s advice lowers BP hile home blood pressure monitoring may be better than office monitoring, there may be another approach to blood pressure control that’s even better. Patients who received free blood pressure monitors and online access to a pharmacist were significantly more successful in controlling their blood pressure than patients who had usual care or those who monitored their blood pressure at home but had no online help from a pharmacist, according to a study conducted at Group Health Cooperative. Moreover, the highest-risk blood pressure patients — those with systolic pressure greater than 160 mm Hg — were among the biggest beneficiaries of home monitoring with pharmacist support. Beverly B. Green, MD, the study’s lead author, says they proved to be most likely to benefit from the approach. “Those with more serious uncontrolled hypertension were over three times as likely to be in control after the intervention than the usual care group,” says Green, a physician and researcher at Group Health. “We were surprised by that. It seems that it doesn’t take a highly intensive intervention to get people with very uncontrolled hypertension into better control.” Results were published in the Journal of the American Medical Association in June 2008. The results of the randomized controlled trial suggest a significant health benefit from sharing W medical information online. Moreover, the study findings indicate that pharmacists who closely monitor patients’ blood pressure levels by way of online communications can generate better health outcomes than physicians who see their patients in the office less frequently. The trial included 778 patients with uncontrolled essential hypertension and Internet access. They were assigned to one of three groups: • Usual care. These patients were told to contact their physicians about their high blood pressure. • Home blood pressure monitoring and Web training. These patients were given a free blood pressure monitor and told to take their blood pressure readings at least twice a week and were trained on how to send an online message to their physician. • Home blood pressure monitoring, Web site training, and care management delivered online by a pharmacist. These patients were also given a free blood pressure monitor and sent their bloodpressure readings to pharmacists every two weeks, using a secure messaging system. The pharmacists were authorized to adjust medication dosages or switch medications, if necessary. “We think the shared medical record was a very important part of this success because there’s more opportunity for communication and decisionmaking along the way,” Green says. for members receiving hemodialysis or peritoneal dialysis in the home.) In their scientific statement, the American Heart Association and two other groups say home monitoring will reduce physician visits and, for some patients, may reduce medication use. However, the paper acknowledges that the issue is more complicated. For one thing, the kind of monitor recommended in the scientific statements costs between $80 and $100, and there is no established fee for paying physicians to validate the accuracy of a patient’s device and to train a patient in its proper use, so the potential cost for that is unknown. Over time, the biggest cost for treating blood pressure is the cost of medication. While patients with white-coat hypertension may end up using less medication, closer at-home monitoring of other patients may reveal a need for more medication. Patric says that Blue Cross Blue Shield of Tennessee looks to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure for guidance on coverage policy. For example, when that committee recommended the use of ambulatory blood pressure monitoring by an automated recorder for some patients, the health plan began to pay for it. The committee, convened every few years by the National Heart, Lung, and Blood Institute, is expected to issue new guidelines in 2009. In the meantime, the Tennessee Blues does pay for blood pressure cuffs in its low-risk case management program. Started in 2007, that program tries to help members with hypertension get better control of their condition through education and casemanagement support. If the case manager thinks an at-home blood pressure monitor will help a patient enrolled in that program, the insurer pays. MC NOVEMBER 2008 / MANAGED CARE 37

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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