Economic evaluation of telephone self-management interventions for blood pressure control.

Abstract

Background

Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study (HINTS), aimed to improve BP control in veterans.

Methods

Eligible veterans were randomized to either usual care or 1 of 3 telephone-based intervention groups using home BP telemonitoring: (1) behavioral management, (2) medication management, or (3) combined. Intervention costs were derived from information collected during the trial. Direct medical costs (inpatient, outpatient, and outpatient pharmacy, including hypertension-specific pharmacy) at 18 months by group were calculated using Veterans Affairs (VA) Decision Support System data. Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care.

Results

Patients receiving behavior or medication management showed significant gains in BP control at 12 months; there were no differences in BP control at 18 months. In subgroup analysis, patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months. In overall and subgroup samples, average intervention costs were similar in the 3 study arms, and at 18 months, there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care.

Conclusions

To optimize investment in telephone-based home interventions such as the HINTS, it is important to identify groups of patients who are most likely to benefit from more intensive home BP management.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.ahj.2012.03.016

Publication Info

Wang, Virginia, Valerie A Smith, Hayden B Bosworth, Eugene Z Oddone, Maren K Olsen, Felicia McCant, Benjamin J Powers, Courtney Harold Van Houtven, et al. (2012). Economic evaluation of telephone self-management interventions for blood pressure control. American heart journal, 163(6). pp. 980–986. 10.1016/j.ahj.2012.03.016 Retrieved from https://hdl.handle.net/10161/30051.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Wang

Virginia Wang

Associate Professor in Population Health Sciences

Dr. Virginia Wang is an Associate Professor in Population Health Sciences and Medicine at the Duke University School of Medicine and Core Faculty in the Duke-Margolis Center for Health Policy. She is also a Core Investigator in the Health Services Research Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Health Care System. Dr. Wang received her PhD in Health Policy and Management, with a focus on organizational behavior. Her research examines organizational influences and policy on the provision of health services, provider strategy and performance, care coordination, and outcomes for patients with complex chronic disease.

Dr. Wang’s research has been supported by the Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases, Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services Office of Minority Health.

Areas of expertise:  health services research, organizational behavior, health policy, implementation and program evaluation
Smith

Valerie A. Smith

Associate Professor in Population Health Sciences

Valerie A. Smith, DrPH, is an Associate Professor in the Duke University Department of Population Health Sciences and Senior Research Director of the Biostatistics Core at the Durham Veterans Affairs Medical Center's Center of Innovation. Her methodological research interests include: methods for semicontinuous and zero-inflated data, economic modeling methods, causal inference methods, observational study design, and longitudinal data analysis. Her current methodological research has focused on the development of marginalized models for semicontinuous data.

Dr. Smith works largely in collaboration with a multidisciplinary team of researchers, with a focus on health policy interventions, health care utilization and expenditure patterns, program and policy evaluation, obesity and weight loss, bariatric surgery evaluation, and family caregiver supportive services.

Areas of expertise: Biostatistics, Health Services Research, Health Economics, and Health Policy

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy


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