Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial

Raj Padwal, Finlay Aleck McAlister, Peter William Wood, Pierre Boulanger, Miriam Fradette, Scott Klarenbach, Alun L Edwards, Jayna M Holroyd-Leduc, Kannayiram Alagiakrishnan, Doreen Rabi, Sumit Ranjan Majumdar, Raj Padwal, Finlay Aleck McAlister, Peter William Wood, Pierre Boulanger, Miriam Fradette, Scott Klarenbach, Alun L Edwards, Jayna M Holroyd-Leduc, Kannayiram Alagiakrishnan, Doreen Rabi, Sumit Ranjan Majumdar

Abstract

Background: Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving "optimal BP control" (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP monitoring is required to achieve this goal. BP monitoring at home is cheap, convenient, widely used, and guideline endorsed. However, major barriers prevent proper use. These may be overcome through use of BP telemonitoring-the secure teletransmission of BP readings to a health portal, where BP data are summarized for provider and patient use, with or without protocolized case management.

Objective: To examine the incremental effectiveness, safety, cost-effectiveness, usability, and acceptability of home BP telemonitoring, used with or without protocolized case management, compared with "enhanced usual care" in community-dwelling seniors with diabetes and hypertension.

Methods: A 300-patient, 3-arm, pragmatic randomized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors' residences in greater Edmonton. Consenting patients will be randomized to usual care, home BP telemonitoring alone, or home BP telemonitoring plus protocolized pharmacist case management. Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data. In both telemonitored arms, providers will receive telemonitored BP data summaries. In the case management arm, pharmacist case managers will be responsible for reviewing teletransmitted data and initiating guideline-concordant and protocolized changes in BP management.

Results: Outcomes will be ascertained at 6 and 12 months. Within-study-arm change scores will be calculated and compared between study arms. These include: (1) clinical outcomes: proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range (110-129 mmHg in patients 65-79 years and 110-139 mmHg in those ≥80 years: primary outcome); additional ambulatory and home BP outcomes; A1c and lipid profile; medications, cognition, health care use, cardiovascular events, and mortality. (2) Safety outcomes: number of serious episodes of hypotension, syncope, falls, and electrolyte disturbances (requiring third party assistance or medical attention). (3) Humanistic outcomes: quality of life, satisfaction, and medication adherence. (4) Economic outcomes: incremental costs, incremental cost-utility, and cost per mmHg change in BP of telemonitoring ± case management compared with usual care (health payor and societal perspectives). (5) Intervention usability and acceptability to patients and providers.

Conclusion: The potential benefits of telemonitoring remain largely unstudied and unproven in seniors. This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes. Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada.

Trial registration: Clinicaltrials.gov NCT02721667; https://ichgcp.net/clinical-trials-registry/NCT02721667 (Archived by Webcite at http://www.webcitation.org/6i8tB20Mc).

Keywords: blood pressure; case management; hypertension; randomized controlled trial; seniors; telemonitoring.

Conflict of interest statement

Conflicts of Interest: TECHNOMED is funded by Canadian Institute for Health Research (CIHR) grant number EH2-143571 and Alberta Innovates Health Solutions grant number 201900506.

RP, SRM, SK, and FAM are supported by an alternative funding plan from the Government of Alberta and the University of Alberta. SK and FM holds salary support awards from Alberta Heritage Foundation for Medical Research and Alberta Innovates-Health Solutions. SRM holds the Endowed Chair in Patient Health Management of the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta. PB holds an Endowed Chair in Healthcare Solutions provided by CISCO Systems Inc. FAM holds the University of Alberta Chair in Cardiovascular Outcomes Research.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Case manager protocol for antihypertensive drug titration.
Figure 3
Figure 3
Overview of economic model.

References

    1. Gee ME, Janssen I, Pickett W, McAlister FA, Bancej CM, Joffres M, Johansen H, Campbell Norman R C Prevalence, awareness, treatment, and control of hypertension among Canadian adults with diabetes, 2007 to 2009. Can J Cardiol. 2012 May;28(3):367–74. doi: 10.1016/j.cjca.2011.08.111.
    1. Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2015 Feb 10;313(6):603–15. doi: 10.1001/jama.2014.18574.
    1. Staessen JA, Gasowski J, Wang JG, Thijs L, Den HE, Boissel JP, Coope J, Ekbom T, Gueyffier F, Liu L, Kerlikowske K, Pocock S, Fagard RH. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000 Mar 11;355(9207):865–72.
    1. Lewington Sarah, Clarke Robert, Qizilbash Nawab, Peto Richard, Collins Rory, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903–13.
    1. Moran AE, Odden MC, Thanataveerat A, Tzong KY, Rasmussen PW, Guzman D, Williams L, Bibbins-Domingo K, Coxson PG, Goldman L. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015 Jan 29;372(5):447–55. doi: 10.1056/NEJMsa1406751.
    1. Daskalopoulou SS, Rabi DM, Zarnke KB, Dasgupta K, Nerenberg K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, McKay DW, Tremblay G, McLean D, Tobe SW, Ruzicka M, Burns KD, Vallée M, Ramesh Prasad G V. Lebel M, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Brian PS, Burgess E, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell Norman RC. Moe GW, Howlett JG, Boulanger J, Prebtani A, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Trudeau L, Petrella RJ, Hiremath S, Stone JA, Drouin D, Lavoie KL, Hamet P, Fodor G, Grégoire JC, Fournier A, Lewanczuk R, Dresser GK, Sharma M, Reid D, Benoit G, Feber J, Harris KC, Poirier L, Padwal RS. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2015 May;31(5):549–68. doi: 10.1016/j.cjca.2015.02.016.
    1. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008 Dec 4;359(23):2417–28. doi: 10.1056/NEJMoa0806182.
    1. Majumdar S. Antihypertensive treatments for adults with type 2 diabetes. BMJ. 2016;352:i560.
    1. Allen M, Kelly K, Fleming I. Hypertension in elderly patients: recommended systolic targets are not evidence based. Can Fam Physician. 2013 Jan;59(1):19–21, 22-4.
    1. Franklin SS. Elderly hypertensives: how are they different? J Clin Hypertens (Greenwich) 2012 Nov;14(11):779–86. doi: 10.1111/j.1751-7176.2012.00703.x.
    1. Cushman William C, Evans Gregory W, Byington Robert P, Goff David C, Grimm Richard H, Cutler Jeffrey A, Simons-Morton Denise G, Basile Jan N, Corson Marshall A, Probstfield Jeffrey L, Katz Lois, Peterson Kevin A, Friedewald William T, Buse John B, Bigger J Thomas, Gerstein Hertzel C, Ismail-Beigi Faramarz. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1575–85. doi: 10.1056/NEJMoa1001286.
    1. Tinetti ME, Han L, Lee David S H. McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014 Apr;174(4):588–95. doi: 10.1001/jamainternmed.2013.14764.
    1. Aronow WS, Fleg JL, Pepine CJ, Artinian Nancy T, Bakris George, Brown Alan S, Ferdinand Keith C, Ann Forciea Mary, Frishman William H, Jaigobin Cheryl, Kostis John B, Mancia Giuseppi, Oparil Suzanne, Ortiz Eduardo, Reisin Efrain, Rich Michael W, Schocken Douglas D, Weber Michael A, Wesley Deborah J, Harrington Robert A, Bates Eric R, Bhatt Deepak L, Bridges Charles R, Eisenberg Mark J, Ferrari Victor A, Fisher John D, Gardner Timothy J, Gentile Federico, Gilson Michael F, Hlatky Mark A, Jacobs Alice K, Kaul Sanjay, Moliterno David J, Mukherjee Debabrata, Rosenson Robert S, Stein James H, Weitz Howard H, Wesley Deborah J. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens. 2011;5(4):259–352. doi: 10.1016/j.jash.2011.06.001.
    1. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008 May 1;358(18):1887–98. doi: 10.1056/NEJMoa0801369.
    1. Cloutier L, Daskalopoulou SS, Padwal RS, Lamarre-Cliche M, Bolli P, McLean D, Milot A, Tobe SW, Tremblay G, McKay DW, Townsend R, Campbell N, Gelfer M. A New Algorithm for the Diagnosis of Hypertension in Canada. Can J Cardiol. 2015 May;31(5):620–30. doi: 10.1016/j.cjca.2015.02.014.
    1. Conen D, Aeschbacher S, Thijs L, Li Y, Boggia J, Asayama K, Hansen TW, Kikuya M, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Gu Y, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Schoen T, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Mena L, Maestre GE, Filipovský J, Imai Y, O'Brien E, Wang J, Risch L, Staessen JA. Age-specific differences between conventional and ambulatory daytime blood pressure values. Hypertension. 2014 Nov;64(5):1073–9. doi: 10.1161/HYPERTENSIONAHA.114.03957.
    1. ESH/ESC Task Force for the Management of Arterial Hypertension 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013 Oct;31(10):1925–38. doi: 10.1097/HJH.0b013e328364ca4c.
    1. Moltu C, Stefansen J, Svisdahl M, Veseth M. Negotiating the coresearcher mandate - service users' experiences of doing collaborative research on mental health. Disabil Rehabil. 2012;34(19):1608–16. doi: 10.3109/09638288.2012.656792.
    1. Staessen J, Den HE, Celis H, Fagard R, Keary L, Vandenhoven G, O'Brien Eoin T, Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) Trial Investigators Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA. 2004 Feb 25;291(8):955–64. doi: 10.1001/jama.291.8.955.
    1. Cappuccio FP, Kerry SM, Forbes L, Donald A. Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ. 2004 Jul 17;329(7458):145. doi: 10.1136/.
    1. Ogedegbe G, Schoenthaler A. A systematic review of the effects of home blood pressure monitoring on medication adherence. J Clin Hypertens (Greenwich) 2006 Mar;8(3):174–80.
    1. Agarwal R, Bills J, Hecht Tyler J W. Light R. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011 Jan;57(1):29–38. doi: 10.1161/HYPERTENSIONAHA.110.160911.
    1. McKay DW, Godwin M, Chockalingam A. Practical advice for home blood pressure measurement. Can J Cardiol. 2007 May 15;23(7):577–80.
    1. Huff LS, Zittleman L, DeAlleaume L, Bernstein J, Chavez R, Sutte C, LeBlanc WG, Parnes B. What keeps patients from adhering to a home blood pressure program? J Am Board Fam Med. 2011;24(4):370–9. doi: 10.3122/jabfm.2011.04.100266.
    1. Milot J, Birnbaum L, Larochelle P, Wistaff R, Laskine M, Van NP, Lamarre-Cliche M. Unreliability of home blood pressure measurement and the effect of a patient-oriented intervention. Can J Cardiol. 2015 May;31(5):658–63. doi: 10.1016/j.cjca.2015.03.006.
    1. Myers MG. Limitations of home blood pressure monitoring in clinical practice. Can J Cardiol. 2015 May;31(5):583–4. doi: 10.1016/j.cjca.2015.03.008.
    1. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013 Mar;31(3):455–67; discussion 467. doi: 10.1097/HJH.0b013e32835ca8dd.
    1. Blood Pressure Lowering Treatment Trialists' Collaboration. Sundström Johan, Arima Hisatomi, Woodward Mark, Jackson Rod, Karmali Kunal, Lloyd-Jones Donald, Baigent Colin, Emberson Jonathan, Rahimi Kazem, MacMahon Stephen, Patel Anushka, Perkovic Vlado, Turnbull Fiona, Neal Bruce. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet. 2014 Aug 16;384(9943):591–8. doi: 10.1016/S0140-6736(14)61212-5.
    1. Reboldi G, Gentile G, Angeli F, Ambrosio G, Mancia G, Verdecchia Paolo. Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73,913 patients. J Hypertens. 2011 Jul;29(7):1253–69. doi: 10.1097/HJH.0b013e3283469976.
    1. Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L, Isham G, Snyder SR, Carande-Kulis VG, Garfield S, Briss P, McCulloch D. The effectiveness of disease and case management for people with diabetes. A systematic review. Am J Prev Med. 2002 May;22(4 Suppl):15–38.
    1. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL. Designing and evaluating complex interventions to improve health care. BMJ. 2007 Mar 3;334(7591):455–9. doi: 10.1136/.
    1. Tricco A, Ivers N, Grimshaw J, Moher D, Turner L, Galipeau J, Halperin I, Vachon B, Ramsay T, Manns B, Tonelli M, Shojania K. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012 Jun 16;379(9833):2252–61. doi: 10.1016/S0140-6736(12)60480-2.
    1. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Tsuyuki R, Grover SA, Dean N, Shuaib A. The preventing recurrent vascular events and neurological worsening through intensive organized case-management (PREVENTION) trial protocol [ identifier: NCT00931788] Implement Sci. 2010;5:27. doi: 10.1186/1748-5908-5-27.
    1. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, Dean N, Bakal JA, Tsuyuki R, Grover S, Shuaib A. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ. 2014 May 13;186(8):577–84. doi: 10.1503/cmaj.140053.
    1. Logan AG, Irvine MJ, McIsaac WJ, Tisler A, Rossos PG, Easty A, Feig DS, Cafazzo JA. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension. 2012 Jul;60(1):51–7. doi: 10.1161/HYPERTENSIONAHA.111.188409.
    1. Moreno L, Dale SB, Chen AY, Magee CA. Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) home telemedicine demonstration: findings from an independent evaluation. Diabetes Care. 2009 Jul;32(7):1202–4. doi: 10.2337/dc09-0094.
    1. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433–41.
    1. Kroenke K, Strine TW, Spitzer RL, Williams Janet B W. Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009 Apr;114(1-3):163–73. doi: 10.1016/j.jad.2008.06.026.
    1. National Institute for HealthClinical Excellence . Hypertension. The clinical management of primary hypertension in adults. Clinical Guideline. London: National Clinical Guideline Centre; 2011. p. 127.
    1. Dasgupta K, Quinn RR, Zarnke KB, Rabi DM, Ravani P, Daskalopoulou SS, Rabkin SW, Trudeau L, Feldman RD, Cloutier L, Prebtani A, Herman RJ, Bacon SL, Gilbert RE, Ruzicka M, McKay DW, Campbell TS, Grover S, Honos G, Schiffrin EL, Bolli P, Wilson TW, Lindsay P, Hill MD, Coutts SB, Gubitz G, Gelfer M, Vallée M, Prasad G V Ramesh. Lebel M, McLean D, Arnold J Malcolm O. Moe GW, Howlett JG, Boulanger J, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Burns KD, Petrella RJ, Hiremath S, Milot A, Stone JA, Drouin D, Lavoie KL, Lamarre-Cliche M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk GB, Burgess E, Lewanczuk R, Dresser GK, Penner SB, Hegele RA, McFarlane PA, Khara M, Pipe A, Oh P, Selby P, Sharma M, Reid DJ, Tobe SW, Padwal RS, Poirier L, Canadian Hypertension Education Program The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2014 May;30(5):485–501. doi: 10.1016/j.cjca.2014.02.002.
    1. Stergiou GS, Giovas PP, Gkinos CP, Patouras JD. Validation of the Microlife WatchBP Home device for self home blood pressure measurement according to the International Protocol. Blood Press Monit. 2007 Jun;12(3):185–8. doi: 10.1097/MBP.0b013e3280b083ce.
    1. O'Brien E, Mee F, Atkins N, O'Malley K. Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens. 1991 Jun;9(6):573–4.
    1. Freitas S, Simões MR, Alves L, Santana I. Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Dis Assoc Disord. 2013;27(1):37–43. doi: 10.1097/WAD.0b013e3182420bfe.
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489–95. doi: 10.1503/cmaj.050051.
    1. EuroQol Group. 2014. [2016-05-12]. EQ-5D: A standardised instrument for use as a measure of health outcome
    1. Kroenke K, Spitzer RL, Williams Janet B W. Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007 Mar 6;146(5):317–25.
    1. Maddigan SL, Majumdar SR, Guirguis LM, Lewanczuk RZ, Lee TK, Toth EL, Johnson JA. Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial. Diabetes Care. 2004 Jun;27(6):1306–12.
    1. Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS. A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med. 2004 Sep 7;141(5):366–73.
    1. Kahlon S, Pederson J, Majumdar SR, Belga S, Lau D, Fradette M, Boyko D, Bakal JA, Johnston C, Padwal RS, McAlister FA. Association between frailty and 30-day outcomes after discharge from hospital. CMAJ. 2015 Aug 11;187(11):799–804. doi: 10.1503/cmaj.150100.
    1. Marshall GN, Hays RD, Mazel R. Health status and satisfaction with health care: results from the medical outcomes study. J Consult Clin Psychol. 1996 Apr;64(2):380–90.
    1. Brouwer W, Rutten F, Koopmanschap M. Drummond M, McGuire A. editors. Economic evaluation in health care: merging theory with practice. Oxford: Oxford University Press; 2001. Costing in economic evaluations; p. 68.
    1. Jacobs P, Roos NP. Standard cost lists for healthcare in Canada. Issues in validity and inter-provincial consolidation. Pharmacoeconomics. 1999 Jun;15(6):551–60.
    1. Majumdar S, Johnson. JA. Bowker S. A Canadian consensus for the standardized evaluation of quality improvement interventions in type 2 diabetes. Can J Diab. 2005;29:220–229.
    1. Graham Timothy A D. Kushniruk AW, Bullard MJ, Holroyd BR, Meurer DP, Rowe BH. How usability of a web-based clinical decision support system has the potential to contribute to adverse medical events. AMIA Annu Symp Proc. 2008:257–61.
    1. Kushniruk AW, Triola MM, Borycki EM, Stein B, Kannry JL. Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application. Int J Med Inform. 2005 Aug;74(7-8):519–26. doi: 10.1016/j.ijmedinf.2005.01.003.
    1. Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104–12. doi: 10.1197/jamia.M1471.
    1. Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004 Feb;37(1):56–76. doi: 10.1016/j.jbi.2004.01.003.
    1. Kushniruk A. Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Comput Biol Med. 2002 May;32(3):141–9.
    1. Kastner M, Lottridge D, Marquez C, Newton D, Straus SE. Usability evaluation of a clinical decision support tool for osteoporosis disease management. Implement Sci. 2010;5:96. doi: 10.1186/1748-5908-5-96.
    1. Daniels J, Fels S, Kushniruk A, Lim J, Ansermino JM. A framework for evaluating usability of clinical monitoring technology. J Clin Monit Comput. 2007 Oct;21(5):323–30. doi: 10.1007/s10877-007-9091-y.
    1. W21C. 2014. [2016-05-12]. Human factors and simulation .
    1. Vizri R. Refining the test phase of usability evaluation: how many subjects is enough. Human Factors. 1992;34:457–468.
    1. Patton M. Qualitative Research and Evaluation Methods. 3rd Edition. California: Sage Publications Inc; 2002.
    1. Simpson S, Lier D, Majumdar S, Tsuyuki R, Lewanczuk R, Spooner R, Johnson J. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet Med. 2015 Jul;32(7):899–906. doi: 10.1111/dme.12692.
    1. Cameron C, Coyle D, Ur E, Klarenbach S. Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin. CMAJ. 2010 Jan 12;182(1):28–34. doi: 10.1503/cmaj.090765.
    1. Cartwright WS. Methods for the economic evaluation of health care programmes, second edition. By Michael F. Drummond, Bernie O'Brien, Greg L. Stoddart, George W. Torrance. Oxford: Oxford University Press, 1997. J Ment Health Policy Econ. 1999 Mar 1;2(1):43.
    1. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000 Aug 12;321(7258):412–9.
    1. Klarenbach S, Cameron C, Singh S, Ur E. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. CMAJ. 2011 Nov 8;183(16):E1213–20. doi: 10.1503/cmaj.110178.
    1. Mount Hood 4 Modeling Group Computer modeling of diabetes and its complications: a report on the Fourth Mount Hood Challenge Meeting. Diabetes Care. 2007 Jun;30(6):1638–46. doi: 10.2337/dc07-9919.
    1. The SPRINT Research Group A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015;373:2103–2116.
    1. Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open. 2013;3(5) doi: 10.1136/bmjopen-2013-002671.
    1. Koopman RJ, Wakefield BJ, Johanning JL, Keplinger LE, Kruse RL, Bomar M, Bernt B, Wakefield DS, Mehr DR. Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned. Telemed J E Health. 2014 Mar;20(3):253–60. doi: 10.1089/tmj.2013.0188.

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