Improving care through telemedicine

High blood pressure is a leading cause of disability and death globally with an estimated 771 thousand Albertans living with the condition. The number of people impacted increases with age, affecting roughly 1 in 4 Canadian adults. High blood pressure can lead to stroke, heart disease, dementia, and kidney failure. What's more, people who have previously experienced a stroke are at an even higher risk of future stroke and death if blood pressure is not adequately controlled.

Monitoring your blood pressure

To ensure that blood pressure levels are within a healthy range, accurate monitoring is required, which is often performed by measuring a person's blood pressure in a medical clinic. This is a practical but flawed approach as blood pressure is sensitive to any anxiety felt by patients while in a clinical setting and may not accurately reflect a patient's actual blood pressure. In addition, travel to a clinic may result in missed appointments as patients balance their daily lives. These challenges can lead to mistreatment of a person's blood pressure and comes with a high cost to the healthcare system.

Dr. Raj Padwal, a high blood pressure specialist at the University of Alberta Hospital and past Chair of the Canadian high blood pressure guidelines, sought to change all that through implementation of a home blood pressure telemonitoring system with pharmacist management.

Previous studies have shown that home blood pressure telemonitoring and case management improves blood pressure control. Other data show that when used in high-risk patients, the method is cost-saving to the healthcare system. However, blood pressure telemonitoring is not used in Alberta because of a lack of Alberta data and uncertainty about how to implement it."
- Dr. Raj Padwal

Managing your blood pressure at home

Home blood pressure telemonitoring involves sending blood pressure readings instantly and securely from a person's blood pressure monitor directly to a web portal. The readings can then be reviewed by a care provider to determine if blood pressure is under control. If not, medication adjustments can be made remotely to ensure the right dose is being used. In Alberta, pharmacists and nurse practitioners can prescribe medication, which makes them perfect candidates for providing these services to Albertans in a cost-effective manner.

Accelerating Innovations into CarE

Padwal's study was supported through the Alberta Innovates Accelerating Innovations into CarE (AICE) Program. AICE supports real-world implementation projects that are carried out by small to medium-sized enterprises (SMEs) and clinical testing sites to generate evidence needed for adoption. During the study, blood pressure telemonitoring and pharmacist case management was provided to 41 stroke patients from Edmonton and Camrose. Pharmacists were provided by Alberta Health Services stroke clinics who monitored patient blood pressure readings over the course of the study and made medication adjustments as necessary. As part of the study, an economic model was created showing that the intervention is cost effective and leads to better health outcomes in Alberta, which was published, alongside an editorial, in the Journal of Clinical Hypertension. Feedback from patients involved in the study was highly positive, and the researchers concluded that blood pressure telemonitoring and pharmacist management, for post stroke patients, is highly feasible, cost-saving, and should be implemented.

The future of blood pressure research

What's next for Dr. Padwal and his research team? He has created a fully functioning telemonitoring system called Sphygmo Home, available on Apple App Store and Google Play in four languages, which uses an innovative approach called Swipe Averaging TM to empower care providers and patients to generate accurate and actionable blood pressure readings. "Our system empowers patients to take control of their blood pressure. Many high-risk patients have uncontrolled blood pressure, but they don't have the knowledge to bring optimal information to their provider. We want to change this and give patients the tools required to self-monitor and optimally manage their blood pressure," says Padwal.

Innovative small to medium sized enterprises (SMEs) with digital or data-enabled health innovations, or health care sites who are interested in implementing new solutions, are encouraged to check out the Accelerating Innovations into CarE (AICE) - Market Access Program at Alberta Innovates. "If you are an SME with an innovative health technology, AICE-Market Access will support you in generating the evidence required for broad market adoption. Our goal is to accelerate traction for innovations that have the power to impact patient care and the health of Albertans," says Graham Anderson, Program Manager of AICE-Market Access at Alberta Innovates, "and we are proud of what Dr. Padwal and AHS have accomplished with this project."

Dr. Padwal's work was originally featured in 2016 when his work with telemonitoring was getting underway.