title: Telemanagement of hypertension: a qualitative assessment of patient and physician preferences.
abstract: BACKGROUND
  Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25%. Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure. Major design flaws and high operating costs, however, have hindered its adoption by physicians and patients.
  
  
  OBJECTIVE
  In the present commentary, the field of telemedicine, as it pertains to hypertension management, is reviewed, and the investigators' experiences in developing a new telemedicine system are outlined.
  
  
  METHODS
  An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system. Opinions were elicited separately from type 2 diabetic patients with hypertension (n=24) and family practitioners in active clinical practice (n=18).
  
  
  RESULTS
  Physician and patient focus group meetings provided key information that led to changes in the prototype system. The low level of computer and Internet use by patients in everyday life and by physicians in practice-related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts. For patients, the mobile phone appeared to be an acceptable alternative. The only practical, automated means to disseminate reports and alerts to physicians was by fax, which was the most universally available device in a doctor's office.
  
  
  CONCLUSIONS
  This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness.
authors.affiliation: Centre for Global eHealth Innovation, University Health Network, Mount Sinai Hospital, Toronto, Ontario.
authors.forename: Nancy V D
authors.initials: NV
authors.lastname: Halifax
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Cafazzo
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Irvine
authors.forename: Melinda
authors.initials: M
authors.lastname: Hamill
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Rizo
authors.forename: Warren J
authors.initials: WJ
authors.lastname: McIssac
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rossos
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D040421:Cell Phone / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000628:therapy; D005194:Family Practice / Q000379:methods; D017144:Focus Groups; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D033181:Information Dissemination / Q000379:methods*; D020407:Internet / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000379:methods*; D017060:Patient Satisfaction; D015397:Program Evaluation; D016636:Telefacsimile / Q000706:statistics & numerical data; D017216:Telemedicine