Tailoring a Telemedicine Hypertension Management Intervention for Patients with High Social Needs or Social Risk Factors

Wake Forest University Health Sciences, Winston-Salem NC

Investigators

Abstract

Clinic-based hypertension care falls short in achieving blood pressure control, particularly for patients with hypertension and high social needs or social risk factors. Sporadic clinic visits do not support adequate time to improve patients’ skills in hypertension self-care or provide reliable and adequate blood pressure values to clinicians to support therapeutic decisions. Telemedicine management of hypertension (TM-HTN) is a team-based approach that overcomes many of the challenges of clinic-based care by offering more time for self-management support and better diagnostic accuracy by leveraging multiple home blood pressure values to support clinicians’ confidence in titrating medications. In a meta-analysis of US-based clinical trials, we found that TM-HTN improved blood pressure by 7.3/2.7 mmHg, compared with usual clinic-based care. However, the effect was significantly diminished in trials that enrolled patients with high social needs or social risk factors (4.4/1.1 mmHg), likely because TM-HTN is not tailored for these patients. Creating a contextually responsive TM-HTN intervention for patients with high social needs or social risk factors and the clinics they attend has the potential to control hypertension in this population who suffer the highest burden and disparity in hypertension control. Our Specific Aims are to: 1) Evaluate barriers and facilitators to TM-HTN use among patients with high social needs or social risk factors, healthcare providers, and health system leaders; 2) Refine TM-HTN intervention for these patients using a Human-Centered Design approach and identify suitable implementation strategies; and 3) Assess feasibility of TM-HTN intervention in a pilot randomized controlled trial. Evaluating the feasibility of the intervention that is responsive to the patient, provider, and system-level contextual factors has the promise to improve blood pressure in patients with high social needs or social risk factors and will help to launch the candidate’s independent patient-oriented research career in cardiovascular disease prevention among vulnerable populations. The candidate has dedicated his professional life to becoming a physician-scientist, studying cardiovascular prevention, epidemiology, and outcomes research. He has accepted a faculty position at the Wake Forest University School of Medicine, where a supportive research environment in the Department of Internal Medicine has made his career advancement and approach to independence possible. To accomplish the goals of the proposed research, he has assembled an experienced mentoring team with unique yet complementary expertise in qualitative and mixed methods, implementation science and clinical trials to guide his career development. The candidate will undertake formal training in these areas to complement his prior medical, graduate, and postgraduate training to transition to independence.