There's A New Sheriff In Town: Home Blood Pressure Telemonitoring & Your Pharmacist
Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
There's a new catchphrase in medicine these days: patient centered medical home or PCMH. Yes, your family doc or general internist will still be team captain but his/her team should be much more involved in your care w/closer & better communication as a key tenet to making this work. Rather than everything being funneled thru your family doc, your nurse practitioner & physician assistant will see you regarding more routine aspects of your care. If you miss a visit, your medical assistant will contact you to check up on you.
Your nutritionist will contact you to be sure you're eating in a healthy fashion (Mediterranean diet, right?) and avoiding 2 weeks' worth of transfat in a single meal. Your diabetic educator will contact you to discuss the latest developments in diabetic care and to be sure you're familiar with how your nutrition & physical activity impacts your health & blood sugars. Your physical therapist will contact you to be make sure you're still exercising regularly using good technique.
But what about your pharmacist? If you've read any of my Avvo and HealthTap posts, you know that I always include them as a resource when patients ask questions related to their medications. After all, pharmacists are the last defense between you and drug-drug (and drug-disease) interactions. Well, in a cluster randomized trial published in today's JAMA, the authors concluded that home blood pressure telemonitoring with medication adjustment by pharmacists improves hypertensive control better than usual care.
The authors followed for up to 18 months 228 patients in clinics randomized to home blood pressure telemonitoring w/pharmacist management compared to 222 patients in clinics randomized to usual care (typically physician-managed based upon sporadic office blood pressure). While the participants only received pharmacist input for 12 months, their blood pressure control remained superior to usual care even at 6 months after intervention.
As I've said, if you haven't noticed, there's change in our future, despite some delays to our nation's healthcare act. There's a new sheriff in town who's instituting a new way of caring for you.