Study shows advantages of SMS over online portals

A simple change to the methods used to virtually engage black patients and doctors can help reduce racial inequities in American telemedicine.

A new research paper from the Perelman School of Medicine at the University of Pennsylvania has shown that black patients with cardiovascular disease covered by Medicaid and Medicare are significantly more likely to share blood pressure measurements with their clinician via text message than an online patient portal of the healthcare system.

The small-scale population results – although possibly the first of their kind conducted during the COVID-19 pandemic – underscore the importance of using patient-preferred technology to drive telehealth practices among patient populations. minority and low income.

Additionally, the findings underscore the need to continually refine the practice of telehealth, system by system, as it becomes more readily adopted during and after the pandemic.

Led by Lauren A. Eberly, MD, MPH, of Perelman’s Division of Cardiovascular Medicine, the researchers sought to assess the adoption and acceptability of a text-based model for home blood pressure monitoring, versus at an online patient portal, among a population of black patients with Medicaid or Medicare insurance who have either hypertension plus cardiovascular disease or are at risk for it.

As the investigators noted, hypertension and medically uncontrolled cardiovascular disease are disproportionately higher in black patients, which likely means that current methods of monitoring and care are not as accepted among these patients.

“Self-measured blood pressure (BP) is associated with better BP control, especially when combined with telemonitoring,” they wrote. “However, disparities in access to telemedicine may limit the benefits of home blood pressure monitoring for black patients.”

Their pilot randomized clinical trial included 20 self-proclaimed black patients with either form of federal insurance who were seen for an in-person cardiology consultation and diagnosed with either hypertension and cardiovascular disease or ≥ 1 factor of cardiovascular risk. Eligible patients spoke English, did not have a blood pressure cuff, and had access to the internet or a phone with texting capability.

From November 2020 to February 2021, patients were randomized in a 1:1 ratio to receive care in the text-based or online Patient Portal. The patient portal, considered a standard care protocol, was accessible through a smartphone app or web browser.

Clinicians provided patients with an automatic Omron arm blood pressure cuff as well as in-person instructions on checking their own blood pressure. The patients were then asked to check their blood pressure twice a day for 14 days.

The text-based group of patients received daily text reminders and an automated response based on their blood pressure measurement. The measurements were sent to the suppliers at the end of the trial period. The online portal group was instructed to register and upload their measurements, either daily or after 14 days.

Investigators gave patients 14 additional dysfunctions to provide measurements at the end of the 14-day measurement period. Investigators looked for a primary outcome of the number of blood pressure measurements and the proportion of patients submitting ≥ 1 measurement. Questionnaires were sent to the patients at the end of the 28-day follow-up.

The patient population of 20 included 10 (50.0%) women and 13 (65.0%) Medicaid recipients. The average age of the patients was 55 years old. Another 17 (85.0%) were diagnosed as obese and 13 (65.0%) had hyperlipidemia.

Each of the 10 patients in the text-based group sent ≥ 1 blood pressure measurement to their clinician, while only 3 (30.0%) patients in the online portal group submitted ≥ 1 measurement (P = 0.001). The average rate of blood pressure measurements submitted per patient was 20.9 in the text-based group, compared with just 3.9 in the online portal group (P <.001>

In the survey response, all 10 patients in the text group described measuring practice as “very easy,” compared to none in the online portal group (P <.001>

The results confirmed that the adoption and satisfaction of a text-based program was higher than that of an online patient portal – a significant but unsurprising result given the historically more untreated patient population in evaluation course.

“Using technology to manage chronic disease can exacerbate health care disparities; however, the type of technology used matters,” the investigators wrote. “Although enrollment in this study required broadband access, access to online patient portals may be prohibitively expensive for patients from historically marginalized groups.”

Eberly and colleagues concluded by noting that the “digital divide” has been well documented among black and low-income patients; previous research during the pandemic also shows significantly lower rates of telemedicine visits among these patients. But text-based communication has always proven to be an effective method for both these patients and their clinicians.

But further research is needed after this pilot test.

“At our institution, a text-based program for blood pressure management in postpartum women has been shown to improve patient outcomes and reduce health care disparities,” the investigators concluded. . “These findings should be confirmed in larger studies, as text-based care may be an effective way to reach patients who have historically experienced barriers to accessing care for chronic conditions.”

The study, “Evaluation of Online Patient Portal vs Text-Based Blood Pressure Monitoring Among Black Patients With Medicaid and Medicare Insurance Who Have Hypertension and Cardiovascular Disease,” was published online in Open JAMA Network.

Comments are closed.