A new emergency department (ED) intervention aimed at helping hypertension patients lower their systolic blood pressure (SBP) could provide considerable value, according to a new analysis published in the Journal of the American Heart Association.[1]
“ED visits can be viewed as opportunities to identify patients at risk for poor control of chronic conditions such as hypertension and related adverse health outcomes such as stroke or heart failure,” wrote first author Andrew Spieker, PhD, an assistant professor of biostatistics at Vanderbilt University Medical Center, and colleagues. “In primary care settings, successful chronic disease management interventions often address multiple determinants of health behavior simultaneously. While several ED‐based intervention bundles have been developed for other conditions such as substance use disorders, few have specifically targeted hypertension self‐management.”
Spieker et al. enrolled 206 patients at a single health system from February 2016 to January 2018. All patients were between the ages of 21 and 84 years old, and exclusions were made if they were already on at least one antihypertensive medication. The Vanderbilt Emergency Room Bundle (VERB) intervention was used with 101 patients. The remaining 105 patients made up the study’s control group.
The VERB intervention included an “educational toolkit” designed specifically with “racially and socioeconomically diverse populations” in mind, a motivational interview, a pill box and pharmacy resources designed to improve medication adherence. Each participant’s primary care provider (PCP) was also contacted, letting them know the patient had been selected for this intervention. Health goals were also established for each individual, and text message alerts were put in place for patients who wished to receive them.
Members of the study’s control group, on the other hand, were given educational materials from the National Institutes of Health (NIH).
“No specific effort was made to review these materials unless participants had specific questions,” the authors wrote.
Overall, the researchers found, implementing this new intervention only took an additional 12 minutes than normal care. After 30 days, the mean SBP among patients in the VERB group was 3.98 mm Hg lower than it was among patients in the control group.
“The VERB intervention warrants further evaluation as a scalable means of engaging patients in ED on hypertension control while they safely make the transition back to primary care for long‐term management,” the authors wrote. “Although effects were small, individual incremental improvements in adherence, self‐care, or blood pressure have important implications on a population level.”
Also, among a smaller subgroup of patients that were sent text messages, the median response rate to those messages was 56%. Patients in the VERB group who received text messages were associated with a slightly lower mean 30-day SBP.
“An interactive text messaging intervention in the ED is a promising approach for identifying and engaging with otherwise difficult‐to‐reach or high‐risk patients,” the authors wrote.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.