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Walking in Patients' Shoes: My Home Blood Pressure Monitoring Experience


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Walking in Patients' Shoes: My Home Blood Pressure Monitoring Experience

  1. 1. Walking in patients’ shoes: home blood pressure monitoring Ted Eytan, MD MS MPH August 18, 2009 Conflict of Interest: I do not have any financial interest or ties to, and have not received any honoraria from, pharmaceutical or device manufacturers. There is no implied or explicit endorsement of any third party products or services. see:
  2. 2. Subtitle Innovation comes in many forms!
  3. 3. Why Home Monitoring? Evidence that it is probably as good if not better than office based diagnosis It is likely superior to ongoing monitoring and treatment, especially in chronic conditions 42-50% of patients controlled under treatment may have masked hypertension More analysis at hypertension Sources: Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P, Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring [Internet]. J. Hypertens. 2008 Aug ;26(8):1505-1526.[cited 2009 Aug 18 ] Available from:   Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association [Internet]. Hypertension. 2008 May 22;HYPERTENSIONAHA.107.189010.[cited 2008 May 23 ] Available from: http:/ / abstract/HYPERTENSIONAHA.107.189010v1  
  4. 4. What did I do? Performed a home blood pressure (HBP) monitoring sequence on myself Used social media to track my progress (hashtag = #homebp) and get feedback
  5. 5. The Device Microlife HomeBP* Innovative in promoting accurate monitoring Adherent to ESH/ AHA guidelines Perhaps a more important innovation than connectivity *Device was loaned to me and then returned
  6. 6. The Innovation Focus: accurate blood pressure measurement Coaches and guides patients : right place, right time, number of times Investment in patient education, see http:// patients/correctbp/
  7. 7. Twitterfeed of my experience
  8. 8. What I Learned Optimal technique is challenging! I needed to SLOW DOWN in the morning to allow for “resting” blood pressure Watch OTC meds (eg pseudephedrine for bad DC allergies!) Dealing with Travel/time zones I CARE about the results
  9. 9. WatchBP Home Software Averages readings according to guidelines Includes omission of the first day (per guideline) Physicians can exclude specific readings from the average
  10. 10. Reactions: A fellow physician
  11. 11. Reactions: Fellow patients
  12. 12. Is it patient centered? YES, if patients are aware of the evidence behind accurate measurement. “At present,HBPM is frequently performed by patients on their own initiative using devices purchased without medical advice. This leads to frequent problems, such as the use of in accurate devices and errors in measurement methodology. The knowledge of patients about appropriate cuff size is also minimal.” - ESH Guidelines for Blood Pressure Monitoring at Home
  13. 13. The Future “headless” biometric device? (will we ever see one?) Integration with personal health record systems and health systems in general Patient participation Source: in understanding how read/2009/07/13/6274/diabetes-and-the- iphone/ accurate HBPM works!
  14. 14. Conclusions Accuracy takes work More patient involvement is better in health care process AND design of it Innovation can happen in process AND/OR technology Solve problems as close to the patient as possible More features at the expense of accuracy does not help patients
  15. 15. Continue the Conversation! Blog: Twitter: tedeytan Articles: Acknowledgements: Wei-Jung Lo, Vice President of Operations, Microlife Medical Home Solutions, Inc. Fellow patients who watched me learn and provided input