Abstract
Objectives: We aimed to assess the feasibility of a text messaging intervention by determining the proportion of emergency department (ED) patients who responded to prompted home blood pressure (BP) self-monitoring and had persistent hypertension. We also explored the effect of the intervention on systolic blood pressure (sBP) over time. Methods: We conducted a randomized, controlled trial of ED patients with expected discharge to home with elevated BP. Participants were identified by automated alerts from the electronic health record. Those who consented received a BP cuff to take home and enrolled in the 3-week screening phase. Text responders with persistent hypertension were randomized to control or weekly prompted BP self-monitoring and healthy behavior text messages. Results: Among the 104 patients enrolled in the ED, 73 reported at least one home BP over the 3-week run-in (screening) period. A total of 55 of 73 reported a home BP of ≥140/90 and were randomized to SMS intervention (n = 28) or control (n = 27). The intervention group had significant sBP reduction over time with a mean drop of 9.1 mm Hg (95% confidence interval = 1.1 to 17.6). Conclusions: The identification of ED patients with persistent hypertension using home BP self-monitoring and text messaging was feasible. The intervention was associated with a decrease in sBP likely to be clinically meaningful. Future studies are needed to further refine this approach and determine its efficacy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 517-527 |
| Number of pages | 11 |
| Journal | Academic Emergency Medicine |
| Volume | 26 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2019 |
Funding
From the Department of Emergency Medicine (WJM), the Department of Neurology (WJM, MD, DB, LS), and the Stroke Program (WJM, MD, DB, LS), University of Michigan, Ann Arbor, MI; Mercy Medical Center-ER EPMG of Clinton, PC (DD), Clinton, IA; the Oakland University William Beaumont School of Medicine (SO), Royal Oak, MI; and the Columbia University School of Nursing (VG), New York, NY. Received October 23, 2018; revision received December 21, 2018; accepted December 22, 2018. This study was registered on ClincialTrials.gov concurrent with initiation of enrollment (NCT02301455) in Fall 2014. Dr. Meurer and Dr. Skolarus had full access to the data and vouch for its integrity. The final deidentified analytical data set is available from Dr. Skolarus and Dr. Meurer contingent upon execution of a data use agreement in accordance with requirements of the University of Michigan. This study was supported in part by the University of Michigan Cardiovascular Center Inaugural award (LS) and by the University of Michigan Department and Emergency Medicine through PI discretionary funds. In addition, the University of Michigan Undergraduate Research Opportunity Program provided partial funding. Finally, analytic work was supported by the National Institutes of Health, National Institute of Minority Health and Disparities, R01-MD011516. The authors have no potential conflicts to disclose. Author contributions: WJM, LS, and DB conceived the study, designed the trial, and obtained research funding; WJM, LS, and MD supervised the conduct of the trial and data collection; DD, SO,VG, and MD undertook recruitment of patients and managed the data, including quality control; WJM provided statistical advice on study design and analyzed the data; WJM drafted the manuscript; and all authors contributed substantially to its revision. WJM takes responsibility for the paper as a whole Supervising Editor: Stephen W. Smith, MD. Address for correspondence and reprints: William J. Meurer, MD, MS; e-mail: [email protected]. ACADEMIC EMERGENCY MEDICINE 2019;26:517–527.
ASJC Scopus subject areas
- Emergency Medicine