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Impact of Blood Pressure Telemonitoring on Hypertension Outcomes: A Literature ReviewAuthor: Azza AbuDagga, Helaine Resnick and Majd AlwanPublication Date: September 2010A literature review was conducted from 1995 to September 2009 to collect evidence on the impact of blood pressure (BP) telemonitoring on BP control and other outcomes in telemonitoring studies targeting patients with hypertension as a primary diagnosis. The findings showed that BP telemonitoring resulted in reduction of BP in all but two studies; systolic BP declined by 3.9 to 13.0mm Hg and diastolic BP declined by 2.0 to 8.0mm Hg across these studies. These magnitudes of effect are comparable to those observed in efficacy trials of some antihypertensive drugs. Although BP control was the primary outcome of these studies, some included secondary outcomes such as healthcare utilization and cost. Evidence of the benefits of BP telemonitoring on these secondary outcomes is less robust. Compliance with BP telemonitoring among patients was favorable, but compliance among participating healthcare providers was not well documented. The potential role of BP telemonitoring in the reduction of BP is discussed and suggestions on priority populations that can benefit from this technology are presented.
Community-Based Telemonitoring for Hypertension Management: Practical Challenges and Potential SolutionsAuthor: Hovey, L, Kaylor, MB, Alwan, M and Resnick, HEPublication Date: August 2011Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors' experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence. Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization. The aim of this report is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. This article reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.
Diabetes in U.S. Nursing Homes, 2004Author: Helaine Resnick, Janice Heineman, Robyn Stone and Ronald I. ShorrPublication Date: February 2008The 2004 National Nursing Home Survey collected cross-sectional data for 11,939 nursing home residents aged >65 years representing approximately 1.32 million individuals. That year, 24.6% of nursing home residents had diabetes as a primary admission and/or current diagnosis. Diabetes was present in 22.5% and 35.6% of white and nonwhite residents, respectively. Diabetic residents were admitted more often from acute care hospitals (42.5 vs. 35.3%), were more likely to have a length of stay >100 days (22.6 vs. 20.1%), and took more medications (10.3 vs. 8.4). Diabetic residents had 39% higher odds of having emergency department visits in the previous 90 days and 56% higher odds of having a pressure ulcer at the time of the survey. In the U.S. in 2004, one in four nursing home residents aged >65 years had diabetes, and these residents had increased odds of several unfavorable outcomes that are important for care planning.
Documentation of Sleep Apnea in United States Nursing Homes, 2004Author: Helaine Resnick and Barbara PhillipsPublication Date: 2008This report defines the prevalence of documented sleep apnea in U.S. nursing home residents and examines characteristics associated with sleep apnea in this population. The key findings were up to 16 diagnoses were abstracted from the medical record at the time of the survey and residents with any of 10 ICD-9 codes for sleep apnea were identified. Sleep apnea was documented in 0.5% of U.S. nursing home residents. The unexpectedly small proportion of NH residents with documented sleep apnea precluded analyses of correlates of this condition in U.S. nursing home residents. In 2004, sleep apnea was virtually undocumented among U.S. nursing home residents. The near absence of recorded apnea may be due to selective mortality associated with sleep apnea, a perception on the part of physicians that apnea is a low priority or low impact condition in the context of the multiplicity of comorbidities in this patient population, or a combination of these and other factors.