Smartphone-based strategy improves linkage to care in patients with elevated BP
PARIS — A strategy of tailored behavioral communication combined with smartphone technology implemented by community health workers conferred improvements in linkage to care for patients with elevated BP, but did not appear to yield a statistically significant improvement in BP reduction.
In the LARK Hypertension Study presented at the European Society of Cardiology Congress, researchers found that in a cohort of 1,460 patients with elevated BP who underwent either usual care, paper-based care or smartphone-based care for the reduction of systolic BP, patients who received care by usual or smartphone methods had greater linkage to care than patients receiving the paper-based strategy.
The systolic BP reduction in the smartphone group was modestly greater but not statistically significantly better than that observed in the usual-care group (–13.1 mm Hg vs. –9.7 mm Hg).
The findings were simultaneously published in the Journal of the American College of Cardiology.
“What we decided to try and test out was whether community health workers equipped with smartphone technology and a behavioral communication strategy could help with initial linkage into care, getting people engaged in the care system, and maintaining them in care,” Rajesh Vedanthan, MD, MPH, FACC, FAHA, Associate Professor at NYU School of Medicine, told Healio. “What we found was that the smartphone-based arm did improve linkage to care and improved BP a modest amount, although the BP results in the end were not statistically significant. The conclusion is that community health workers have a role and quite likely can improve linkage and BP if they're equipped with smartphones and behavioral communication,” said Dr. Vedanthan, who collaborates with Dr. Valentin Fuster at Icahn School of Medicine at Mount Sinai (Principal Investigator of the study).
In this three-arm, cluster-randomized trial, researchers studied improvements in BP as well as linkage to care in western Kenya by comparing usual, paper and smartphone-based care strategies in a cohort of patients with elevated BP (58% women; mean age, 54 years; mean baseline systolic BP, 159.4 mm Hg)
The three arms utilized strategies including:
- usual care, which featured standard training;
- paper-based care, which featured tailored behavioral communication and use of paper-based tools; and
- smartphone-based care which featured tailored behavioral communication and use of smartphone technology.
“[Getting] people linked into care, engaged with care and maintained with care is critically important,” Vedanthan said in an interview. “Community health workers with technology can help, but other innovations and issues need to be addressed.”
According to the authors, study limitations included issues with self-reported data, missing data, and differential times to follow up. Further research is being conducted within this region in the ongoing NIH-funded BIGPIC study, according to Vedanthan.
“BIGPIC is actually addressing ... those other issues [including] the financial burden of people's engagement in the medical care system, whether it's cost of medications, cost of transport, opportunity costs of lost work, etc.,” Vedanthan said in an interview. “The financial issues are a major concern for individuals and for patients, and our BIGPIC trial is trying to tackle that issue head on by combining economic interventions with medical interventions.” – by Scott Buzby
Vedanthan R, et al. Abstract 3218. Presented at: European Society of Cardiology Congress; Aug. 31 to Sept. 4, 2019; Paris.
Disclosure: Vedanthan reports no relevant financial disclosures.