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The American Journal of Managed Care September 2013
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Improving BP Control Through Electronic Communications: An Economic Evaluation
Paul A. Fishman, PhD; Andrea J. Cook, PhD; Melissa L. Anderson, MS; James D. Ralston, PhD, MPH; Sheryl L. Catz, PhD; David Carrell, PhD; James Carlson, PharmD; and Beverly B. Green, MD, MPH
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Improving BP Control Through Electronic Communications: An Economic Evaluation

Paul A. Fishman, PhD; Andrea J. Cook, PhD; Melissa L. Anderson, MS; James D. Ralston, PhD, MPH; Sheryl L. Catz, PhD; David Carrell, PhD; James Carlson, PharmD; and Beverly B. Green, MD, MPH
Home blood pressure (BP) monitoring and use of secure webbased tools to manage care collaboratively with pharmacists is a cost-effective way to improve BP control.
The majority of our study population was white and had a college degree, and web access was required, limiting the generalizability of our findings. Study participants might have been more responsive to the interventions offered and in particular have greater access to and facility with web-based health services than a group that is more representative of the entire United States. Thus the success of extending programs such as the e-BP to more diverse populations may depend on adapting the manner in which patients can access their health records and care teams to include the full range of technological solutions available in the marketplace.

Second, our analysis was conducted from a health plan perspective and we did not calculate any costs incurred by patients. Third, the e-BP trial did not directly compare webbased care to planned physician or pharmacist in-person office visits for the purposes of improving BP control. Future studies should compare the costs of in-person, telephone, and web-based delivery modes and determine the optimal “dose” of collaborative care for improving BP control long term. Finally, we could not examine the full set of potential long-term benefits of our intervention, as results were based on 1-year follow-up. However, it is possible that patients receiving training in self-management might have more sustained BP control over time.


Our analyses suggest that the clinical success of the e-BP trial can be achieved with a relatively low short- and longterm ICER relative to UC approach to hypertension management. We demonstrated that it is possible to significantly improve hypertension control with a program that is relatively low cost and future research should examine the cost impact of potential long-term clinical improvements.

Author Affiliations: From Group Health Cooperative (PAF, AJC, JDR, SLC, JC), Group Health Research Institute, Seattle, WA; Group Health Research Institute (DC, BBG), Seattle, WA.

Funding Source: Research was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH): Grant #1 R01 HL075263-01.

Author Disclosures: The authors (PAF, AJC, MLA, JDR, SLC, DC, JC, BBG) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (PFA, AJC, SLC, JC, BBG); acquisition of data (PFA, DC, BBG); analysis and interpretation of data (PFA, AJC, MLA, SLC, BBG); drafting of the manuscript (PFA, MLA, BBG); critical revision of the manuscript for important intellectual content (PFA, AJC, SLC, BBG); statistical analysis (PFA, AJC, MLA, BBG); provision of study materials or patients (PFA, BBG); obtaining funding (PFA, BBG); administrative, technical, or logistic support (PFA, BBG); and supervision (PFA, BBG).

Address correspondence to: Paul A. Fishman, PhD, Group Health Cooperative, Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101. E-mail:
1. Institute of Medicine (US); Committee on Public Health Priorities to Reduce and Control Hypertension in the US Population. A Population- Based Policy and Systems Change Approach to Prevent and Control Hypertension. Washington, DC: National Academies Press; 2010.

2. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and  control rates in United States adults between 1988-1994 and 1999-2004. Hypertension.2008;52(5):818-827.

3. Green BB, Ralston JD, Fishman PA, et al. Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Contemp Clin Trials. 2008;29(3):376-395.

4. Green BB, Cook AJ, Ralston JD, et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008;299(24):2857-2867.

5. Ralston JD, Martin DP, Anderson ML, et al. Group health cooperative’s transformation toward patient-centered access. Med Care Res Rev. 2009;66(6):703-724.

6. Coleman A, Steel S, Freeman P, de Greeff A, Shennan A. Validation of the Omron M7 (HEM-780-E) oscillometric blood pressure monitoringdevice according to the British Hypertension Society protocol. Blood Press Monit. 2008;13(1):49-54.

7. Verberk WJ, Kroon AA, Kessels AG, de Leeuw PW. Home blood pressure measurement: a systematic review. J Am Coll Cardiol. 2005;46(5):743-751.

8. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.

9. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich). 2012;14(1):51-65.

10. Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions: part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770-1781.

11. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease  risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441-1453.

12. Walsh JM, McDonald KM, Shojania KG, et al. Quality improvement strategies for hypertension management: a systematic review. Med Care. 2006;44(7):646-657.

13. Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009;169(19):1748-1755.

14. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and metaanalyses. Med Care. 2010;48(10):923-933.

15. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010(3):CD005182.

16. Gold MR. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.

17. Drummond MF, O’Brien BJ, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. New York: Oxford University Press; 2005.

18. Actuarial Publications. .html. Accessed June 1, 2011.

19. Kiiskinen U, Vartiainen E, Pekurinen M, Puska P. Does prevention of cardiovascular diseases lead to decreased cost of illness? twenty years of experience from Finland. Prev Med. 1997;26(2):220-226.

20. Kiiskinen U, Vartiainen E, Puska P, Aromaa A. Long-term cost and life-expectancy consequences of hypertension. J Hypertens. 1998;16(8): 1103-1112.

21. Franco OH, de Laet C, Peeters A, Jonker J, Mackenbach J, Nusselder W. Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern Med. 2005;165(20):2355-2360.

22. Franco OH, Peeters A, Bonneux L, de Laet C. Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Hypertension. 2005;46(2):280-286.

23. Gudmundsson LS, Johannsson M, Thorgeirsson G, Sigfusson N, Sigvaldason H, Witteman JC. Hypertension control as predictor of mortality in treated men and women, followed for up to 30 years. Cardiovasc Drugs Ther. 2005;19(3):227-235.

24. Frick KD. Microcosting Quantity Data Collection Methods. Medical Care. 2009;47(7):S76-S81.

25. Polsky D, Glick HA, Willke R, Schulman K. Confidence intervals for cost-effectiveness ratios: a comparison of four methods. Health Econ. 1997;6(3):243-252.

26. Jimison H, Gorman P, Woods S, et al. Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. Evid Rep Technol Assess (Full Rep). 2008(175):1-1422.

27. Soghikian K, Casper SM, Fireman BH, et al. Home blood pressure monitoring: effect on use of medical services and medical care costs. Med Care. 1992;30(9):855-865.

28. Okamoto MP, Nakahiro RK. Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic. Curr Hypertens Rep. 2002;4(6): 418-418.

29. Reed SD, Li Y, Oddone EZ, et al. Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension. Am J Hypertens. 2010;23(2):142-148.
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