Might “Telemedicine” Simply Mean “More Medicine” For Hypertension Patients?

“The goal of telemedicine is to reduce disease and the burden on the healthcare system in a cost-effective way. By showing that a relatively low-cost, internet-based telemedicine system can change physicians’ prescribing habits and perhaps [lower] blood pressures, this can lead to obvious benefits to patients and the healthcare system.”

In short

Positively our last reference to the American College of Cardiology (ACC) Annual Scientific Session in Chicago this week, with the publication of research suggesting that, at face value, internet-based telemedicine systems appear to lead to “more appropriate and effective pharmacotherapy, better blood pressure control and an overall reduction in cardiovascular risk compared to conventional, periodic office visits.”

The researchers claim a higher number of medications ordered in the telemedicine arm of this randomised, controlled study demonstrate better treatment for the group.

Background 

In an article on diagnostic and interventional cardiology site dicardiology.com, which can be found here, a treatment group of patients who reported their blood pressure readings via a web-based portal, received more timely treatment decisions and medication adjustments from their health care team compared to a control group of hypertensive patients who had routine office visits.

Patients from two large medical centers were recruited and randomised to receive either usual care or telemedicine with usual care. Patients in the telemedicine group were asked to report their blood pressure, heart rate, weight, steps taken per day, and tobacco use twice weekly for six months. By the end of the six-month intervention, medications prescribed to those in the control group were virtually unchanged, while there was a small, but significant, increase in the number of medications ordered ( 2.20 ± 1.20 to 2.34 ±1.15, p=0.004) for patients in the telemedicine group.

Investigator comments 

“The ongoing monitoring and reporting of blood pressure levels seems to bring about important changes in physician prescribing habits, which we think ultimately benefit patients,” said Val Rakita, M.D., internal medicine resident at Temple University Hospital and the study’s co-investigator. “Based on our findings, physicians appear to prescribe more blood pressure medications for those patients who continue to have high blood pressure despite the medications they are on. In fact, in one subset of patients, not only did we find they were prescribed more blood pressure medications, it also actually led to a larger blood pressure reduction compared to all other groups.”

Rakita says that prescribing more medication in the telemedicine group did not signify over treatment, but was a reflection of more timely decisions to increase and/or adjust medications based on patient self-monitoring and reporting.

We say

Don’t get us wrong on this. We’re big advocates of telemedicine. A claim of equivalence would probably have done the job, but claiming that a small (albeit statistically significant) increase in medication is due to earlier or better diagnosis might be a conclusion too far, might it not? Given that there was no significant difference in the blood pressure between the two groups overall, except in one subset, we think that claim remains slightly more open than that.

The researchers’ assert that it is “reasonable to believe that the use of additional blood pressure medications in the telemedicine group would have translated to an associated drop in blood pressure in these patients had they been followed for a longer period of time”.

That’s good, but this really isn’t a test for telemedicine is it? If it was, the researchers would have been making sure that the control group were receiving a somehow measured equivalent level of interaction. What this study might show is that more care results in more medication? If you think about it, why does it matter? If telemedicine delivers more care cheaper than conventional treatment, yet has the potential to generate better patient outcomes, everyone’s a winner.

Source: dicardiology.com