(590) Patient, clinician and administrator perspectives on a home remote blood pressure monitoring program

Remote home blood pressure (BP) monitoring improves postpartum BP acquisition, mitigates racial disparities in follow-up, reduces urgent postpartum care for individuals with hypertensive disorders of pregnancy (HDP). Successful program implementation relies on engagement by patients, clinicians and administrators, but there is a paucity of data on stakeholder perspectives.  We assessed the impact of a 10-day text message support program including escalation of care via phone calls and a telemedicine visit upon completion.

Study Design:

Semi-structured key informant interviews of individuals with HDP (n=10), OB clinicians (n=12) and obstetric hospital administrators (n=4) were performed to assess barriers and facilitators to postpartum transitions to primary care after engagement with remote BP monitoring using the socioecological model at a single academic center. Interviews were coded using grounded theory until thematic saturation was achieved.

Results:
Patients attributed high levels of self-efficacy, i.e. sense of control over their health, due to the program’s behavioral nudges (Table 1). They experienced increased connection with providers with ongoing and rapid engagement by the clinical team. Clinicians and patients felt that this program improved organizational efficiency with clinical decisions (Table 2). Clinicians and administrators appreciated remote care delivery, which increased appointment availability for other issues (Table 2). However, patients desired opportunities for more frequent touchpoints with clinicians regarding other postpartum issues. Patients’ understanding of long-term CVD risks beyond program completion was limited. Some patients desired more in-person care.

Conclusion:
Home blood pressure monitoring is positively perceived by both providers and patients. However, there are unmet opportunities for improved patient education about long-term CVD risks outside the immediate postpartum period suggesting a critical gap in immediate postpartum provider to longer-term primary care provider transitions.