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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.

CONCLUSION

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: fishman.p@ghc.org.
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