By Melinda Young
When the COVID-19 pandemic disrupted case management, care coordination, transitions, and clinical monitoring of patients with chronic illness, the entire health industry switched to remote monitoring, virtual clinic visits, and virtual case management whenever feasible.
A new study revealed that using self-measured blood pressure (SMBP) monitoring and telehealth were among the top ways healthcare professionals adapted to the pandemic’s forced limits on in-person clinic visits.1
“The pandemic significantly increased telehealth and the use of patient-generated data,” says Margaret Meador, MPH, C-PHI, CPHQ, lead study author and director of quality improvement and integration at the National Association of Community Health Centers (NACHC) in Bethesda, MD. SMBP monitoring can provide better, more actionable data and help patients achieve their blood pressure goals sooner, she says.
Meador and colleagues sent questionnaires to health center clinicians in the spring of 2021, asking for their perspectives on managing hypertension during the pandemic. “We recognized there was an opportunity here,” she says. “We wanted to learn about adaptations being used and what those clinicians felt should be sustained over the long term of hypertension management.”
Meador and colleagues also wanted to understand the challenges clinicians faced when managing hypertension under the pandemic’s most trying circumstances. They contacted clinicians during the height of the pandemic before COVID-19 vaccines were widely available.
“Recognizing that adverse situations can often lead to innovation and creative solutions, we wanted to hear from those on the frontlines of healthcare — community health centers — what adaptations or innovations were used and what they felt should be sustained over the long term,” Meador explains. “We found that most patients experienced care delays and disruptions, but health centers quickly pivoted to using SMBP through telehealth. Clinicians pivoted to using telehealth and SMBP to manage and assess patients’ care remotely.”
If patients exhibited blood pressure issues, providers would treat them through telehealth. “We already knew how nimble health centers can be, but I think we were still surprised at how fast they adapted to using SMBP — some in a matter of weeks,” Meador says. “We were also surprised that clinicians’ confidence in using SMBP in treatment decisions significantly increased compared to pre-pandemic. I think another important finding is that most clinicians indicated SMBP should be continued as a standard approach to increase patient access to and engagement with hypertension care.”
Necessity led to these positive outcomes. “Their own necessity to use it caused them to decide it was a strong tool in their hypertension toolkit,” Meador says.
Patients received a home blood pressure monitor to use at home over several days. The device yields a pattern of blood pressure readings over time, which are averaged to inform treatment.
“SMBP also allows for the care team to intensify or adjust treatment without requiring an office visit,” Meador says. “Over 500 health centers continue to use SMBP.”
The NACHC published its initial version of the SMPB Implementation Toolkit in 2020 and its most recent version in 2023.2 Clinicians indicated that self-measured blood pressure should be continued as a standard approach to hypertension management, Meador adds.
It makes sense from an evidence-based perspective, Meador notes. Self-measured blood pressure is easier for patients to access since they can do it in their own homes, and it is a way for patients to take multiple blood pressure readings in their home over several days. The self-measuring device generates readings that can be averaged, and it is more reflective of a patient’s true blood pressure than a single office reading.
“We know that out-of-office SMBP is a superior way to gauge blood pressure, but it wasn’t widely adopted prior to the pandemic,” Meador says. Because of the pandemic, clinicians increased their confidence in the self-measuring tool and said it should continue to be used, she notes.
The positive results for SMBP also might indicate the benefits of other technology-driven patient monitoring and the use of these in patient care management after discharge from the hospital.
“The pandemic significantly increased telehealth and the use of patient-generated data, both of which represent benefits and improvements for patients with chronic diseases,” Meador says. “These are technologies that are patient-centered help engage patients in their own care and meet them where they are.” The pandemic also underscored the importance of how chronic conditions make patients more vulnerable to infectious diseases and showed the importance of focusing on care management, she adds.
In addition to measuring blood pressure, self-measurement technology could assist with the management of diabetes, asthma, and other chronic illnesses. “You can monitor patients remotely and use patient-generated data,” Meador says. “It’s the future of chronic disease management.” Care managers, providers, and others treating patients with chronic illnesses can help engage patients in their own care and meet them where they are, she adds.
A lot of people with COVID-19 had other risk factors, suggesting healthcare leaders need to refocus the need for care management, Meador says. Having patients reduce their visits to clinics and hospitals also can help protect them from infections by keeping them out of places where exposure to infectious diseases is more prevalent.
“The pandemic underscores the importance of how chronic diseases make people more susceptible to infectious diseases,” Meador explains.
Health systems and clinics using self-measuring devices should ensure they obtain validated devices, such as the U.S. Blood Pressure Validated Device Listing, Meador suggests.3 Case managers and others could start research pilot programs and quality improvement projects using self-measuring devices for the highest-risk patients.
“You can always scale it up when you get more funding,” Meador says. “We published the SMBP implementation toolkit, and it was used across the country by many healthcare organizations.”2
Organizations can access the toolkit at no charge, but implementing SMBP costs money that is not always fully covered by payers.
“The biggest challenge is that we need SMBP to be reimbursed adequately and fully in all states, and we need to shift to payment models that reward prevention and proactive chronic disease management,” Meador says.
What Meador’s research and other studies about self-measuring devices and telehealth have shown is that these methods can work well, producing positive outcomes and positive patient experiences.
“This is here to stay, in a good way,” Meador says.
REFERENCES
- Meador M, Sachdev N, Anderson E, et al. Self-measured blood pressure monitoring during the COVID-19 pandemic: Perspectives from community health center clinicians. J Healthc Qual 2023;Dec 27. doi: 10.1097/JHQ.0000000000000417. [Online ahead of print].
- National Association of Community Health Centers. Self-Measured Blood Pressure Monitoring (SMBP) Implementation Toolkit. March 2023.
- U.S. Blood Pressure Validated Device Listing. Blood pressure devices. 2024. http://www.validatebp.org
When the COVID-19 pandemic disrupted case management, care coordination, transitions, and clinical monitoring of patients with chronic illness, the entire health industry switched to remote monitoring, virtual clinic visits, and virtual case management whenever feasible. A new study revealed that using self-measured blood pressure monitoring and telehealth were among the top ways healthcare professionals adapted to the pandemic’s forced limits on in-person clinic visits.
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