Virtual visits effective in maintaining BP control
‘Virtual’ follow-up visits for patients with hypertension appeared to be just as effective as clinic visits in helping maintain blood pressure control. A US study found no significant difference in outcomes, including the need for specialist referrals or hospitalization, between patients checking in with their primary care physicians via a secure website to report aspects of their hypertension care and those who did so in the practice.
Study co-author Dr Ronald Dixon said, “Our central finding was that you can use online, non-simultaneous communication to manage a chronic medical condition without visits to the practice that can be inconvenient for patients and add to demands placed on busy primary care practices.”
The current study compares data and outcomes for 893 patients from primary care practices who had at least one virtual follow-up visit for hypertension with those of a group of 893 patients with similar demographic factors, chronic conditions and cardiovascular risk factors treated for hypertension in primary care practices.
The virtual visits platform allowed patients to enter up to five blood pressure readings, report on whether they were taking medications as directed, describe any side-effects and ask questions. GPs reviewed what patients had entered, made adjustments to treatment, and recommended repeat virtual visits, follow-up phone calls or practice visits.
Over six months, patients in both groups showed similar improvements in blood pressure control and other outcomes. But those in the virtual care group had an average of 0.8 fewer follow-up office visits, a decrease that was even greater among patients whose blood pressure control had been poor upon entry into the study. There were no significant differences between the two groups in specialist visits, A&E visits or hospital admissions for any reason.
· Both groups were approximately 61 years old, 44% female, 85% White, had about five chronic conditions, and about 20% had a mean pre-visit systolic blood pressure of 140-160 mmHg.
· Compared to usual care, virtual visit patients had an adjusted 0.8 (95% CI, 0.3 to 1.2) fewer primary care office visits.
· There was no significant adjusted difference in systolic blood pressure control (0.6 mmHg [95% CI, - 2.0 to 3.1]), specialist visits (0.0 more visits [95% CI, - 0.3 to 0.3]), emergency department visits (0.0 more visits [95% CI, 0.0 to 0.01]), or inpatient admissions (0.0 more admissions [95% CI, 0.0 to 0.1]).
These findings show that a virtual visit can substitute for, rather than add to, an in-person visit, in patients with reasonably well-controlled hypertension, thus decreasing overall health care use. Any measures that could reduce the time and resources needed to provide primary care services without compromising the quality of care or increasing the need for specialty care are welcome.
Levine DM et al. Association of structured virtual visits for hypertension follow-up in primary care with blood pressure control and use of clinical services. J Gen Intern Med 2018. Apr 23. doi: 10.1007/s11606-018-4375-0. [Epub ahead of print]