Blood pressure control in a hypertension telemedicine intervention: does distance to primary care matter?

Abstract

Although telemedicine may help overcome geographic access barriers, it is unknown whether rural patients receive greater benefits. In a secondary analysis of 503 veterans participating in a hypertension telemedicine study, the authors hypothesized that patients with greater travel distances would have greater improvements in 18-month systolic blood pressure (SBP). Patients were categorized by telemedicine exposure and travel distance to primary care, derived from zip codes. Comparisons were (1) usual care (UC), distance <30 miles (reference); (2) UC, distance ≥30 miles; (3) telemedicine, distance <30 miles; (4) telemedicine, distance ≥30 miles. Compared with patients receiving UC, distance <30 miles (intercept=127.7), no difference in 18-month SBP was observed in patients receiving UC, distance ≥30 miles (0.13 mm Hg, 95% confidence interval [-6.6 to 6.8]); telemedicine, distance <30 miles (-1.1 mm Hg [-7.3 to 5.2]); telemedicine, distance ≥30 miles (-0.80 mm Hg [-6.6 to 5.1]). Although telemedicine may help overcome geographic access barriers, additional studies are needed to identify patients most likely to benefit.

©2013 Wiley Periodicals, Inc.

Figures

Figure 1

Flowchart of patients included in the study. HINTS indicates Hypertension Intervention Nurse Telemedicine Study; BP, blood pressure.

Figure 2

Systolic blood pressure at 18 months presented as a change from model intercept, which represents the systolic blood pressure for an average 65‐year‐old male veteran who is white, married, receiving usual care, and travelling

Figure 3

Subgroup analysis showing change in systolic blood pressure at 18 months for patients with uncontrolled systolic blood pressure at baseline (N=175) and patients with diabetes (N=210). The model intercept represents the mean systolic blood pressure for an average 65‐year‐old male veteran who is white, married, receiving usual care, and travelling