Digital HTN, Diabetes Monitoring Program a Boon for Patients

A digital health program for hypertension and diabetes was associated with improved patient outcomes, a clinical pharmacist reported.

While 26% of hypertension patients receiving usual care achieved blood pressure control after 6 months, 75% of those in the digital health program met that goal in the same time frame in 2019, Heather Aaron, PharmD, of Ochsner Health in New Orleans, reported during a presentation at the Midyear American Society of Health-System Pharmacists (ASHP) meeting.

A 2018 analysis done by Ochsner Health showed that medication adherence also improved in patients in the digital health program, while it dwindled in patients receiving usual care, Aaron noted.

Patients with diabetes experienced improved hemoglobin A1c as well, with the average going from 7.3% at baseline to 6.7% after 6 months in the digital health program, Aaron reported. The goal for most adults with diabetes set by the American Diabetes Association is an A1c of 7% or lower. The CDC threshold definition for diabetes is an A1c of 6.5% or higher.

After 6 months in the digital health program, fewer diabetes patients reported extreme diabetes distress, dropping from 9.0% to 5.8%. Diabetes distress is often an unseen effect of managing a chronic disease like diabetes, Aaron said.

The digital health program enables the healthcare team to access much more data, Aaron said. Compared to an average of 10 clinical interactions over 6 months in a usual care setting for a patient with hypertension, there were approximately 130 clinical touches for a participant in the digital health program. These interactions were through messaging, phone calls, and text. For both the diabetes and hypertension programs, greater than 30 times more readings for glucose levels or blood pressure were collected compared with usual care, according to Aaron.

“If a patient’s blood sugar is trending up, we don’t need to wait until we get an elevated A1c in 6 months,” Aaron said. Because they can access a patient’s data in real time, the healthcare team is able to respond much sooner and can proactively manage the patient, she said.

During the pandemic, the program saw its enrollment grow substantially, from nearly 9,000 in January 2020 to more than 14,000 in December 2020, Aaron noted. As of September 2021, the program had ​​13,800 hypertension patients and 2,700 diabetes patients.

Patients use a glucometer or blood pressure monitor to send data to the healthcare team. The data is sent via Bluetooth to the patient’s smartphone. The program asks that patients with hypertension send blood pressure readings at least once a week and that patients with diabetes send blood glucose readings based on their prescribed frequencies.

The clinical pharmacists review and analyze the patients’ home data and reach out to the patients based on their progress. They also reach out if they see acute changes in patients’ data trends.

Aaron acknowledged that, because some insurance companies do not cover the cost of the glucometer used in the program, some patients end up not enrolling. On the other hand, blood pressure monitors are usually less expensive, with a one-time cost of approximately $35, Aaron said.

More recently, the program implemented a pilot study for Medicaid patients who receive all devices free of charge, Aaron added.

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