Ann Intern Med. 2023 Nov 7. doi: 10.7326/M23-1182. Online ahead of print.
ABSTRACT
BACKGROUND: Remote patient monitoring (RPM) is a promising tool for improving chronic disease management. Use of RPM for hypertension monitoring is growing rapidly, raising concerns about increased spending. However, the effects of RPM are still unclear.
OBJECTIVE: To estimate RPM’s effect on hypertension care and spending.
DESIGN: Matched observational study emulating a longitudinal, cluster randomized trial. After matching, effect estimates were derived from a regression analysis comparing changes in outcomes from 2019 to 2021 for patients with hypertension at high-RPM practices versus those at matched control practices with little RPM use.
SETTING: Traditional Medicare.
PATIENTS: Patients with hypertension.
INTERVENTION: Receipt of care at a high-RPM practice.
MEASUREMENTS: Primary outcomes included hypertension medication use (medication fills, adherence, and unique medications received), outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending.
RESULTS: 192 high-RPM practices (with 19 978 patients with hypertension) were matched to 942 low-RPM control practices (with 95 029 patients with hypertension). Compared with patients with hypertension at matched low-RPM practices, patients with hypertension at high-RPM practices had a 3.3% (95% CI, 1.9% to 4.8%) relative increase in hypertension medication fills, a 1.6% (CI, 0.7% to 2.5%) increase in days’ supply, and a 1.3% (CI, 0.2% to 2.4%) increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters (-9.3% [CI, -20.6% to 2.1%]) and reduced testing use (-5.9% [CI, -11.9% to 0.0%]). However, these patients also saw increases in primary care physician outpatient visits (7.2% [CI, -0.1% to 14.6%]) and a $274 [CI, $165 to $384]) increase in total hypertension-related spending.
LIMITATION: Lacked blood pressure data; residual confounding.
CONCLUSION: Patients in high-RPM practices had improved hypertension care outcomes but increased spending.
PRIMARY FUNDING SOURCE: National Institute of Neurological Disorders and Stroke.
PMID:37931262 | DOI:10.7326/M23-1182
