title: Are telehealth technologies for hypertension care and self-management effective or simply risky and costly?
abstract: Hypertension is a prevalent chronic disease that requires ongoing management and self-care. The disease affects 31% of American adults and contributed to or caused the deaths of 348,000 Americans in 2008, fewer than 50% of whom effectively self-managed the disease. However, self-management is complex, with patients requiring ongoing support and easy access to care. Telehealth may help foster the knowledge and skills necessary for those with hypertension to engage in successful self-management. This paper considers the applicability, efficacy, associated risks, and cost-effectiveness of telehealth for individuals and populations with hypertension. Telehealth is a broad term, encompassing telemedicine and mobile health that is used for physician-patient interactions, diagnostics, care delivery, education, information sharing, monitoring, and reminders. Telemedicine may have considerable utility for people diagnosed with hypertension who have poor access or social barriers that constrain access, but potential risks exist. Telehealth technology is evolving rapidly, even in the absence of fully proven cost-effectiveness and efficacy. Considering the cost of inpatient and emergency department care for patients with hypertension, telehealth is a highly attractive alternative, but there are risks to consider. Incorporating telehealth, which is increasingly characterized by mobile health, can increase both the capacity of health care providers and the reach of patient support, clinical management, and self-care. Telehealth studies need improvement; long-term outcome data on cardiovascular events must be obtained, and robust risk analyses and economic studies are needed to prospectively evaluate the safety and cost savings for hypertension self-management.
authors.affiliation: 1Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: June
authors.initials: J
authors.lastname: McKoy
authors.affiliation: 2DePaul University, Chicago, Illinois.
authors.forename: Karen
authors.initials: K
authors.lastname: Fitzner
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Miranda
authors.initials: M
authors.lastname: Margetts
authors.affiliation: 4UC Scout from University of California, Santa Cruz, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Heckinger
authors.affiliation: 5American Association of Diabetes Educators, Chicago, Illinois.
authors.forename: James
authors.initials: J
authors.lastname: Specker
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Laura
authors.initials: L
authors.lastname: Roth
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Izenberg
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Molly
authors.initials: M
authors.lastname: Siegel
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Shannon
authors.initials: S
authors.lastname: McKinney
authors.affiliation: 3FH Consultants, Chicago, Illinois.
authors.forename: Gail
authors.initials: G
authors.lastname: Moss
mesh_terms: D000368:Aged; D015438:Health Behavior; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D012648:Self Care; D017216:Telemedicine / Q000191:economics