Introduction: Telehealth (TH) uses telecommunication technology (e.g. internet, telephone, mobile or smart phone) as a cost-effective way to provide healthcare delivery for hypertension (HTN) control. However, effectiveness of TH on HTN control among disparate populations is unclear.
Methods: We conducted a systematic review using the Cochrane methods to assess effectiveness of TH for HTN control in disparate people diagnosed with HTN. Participants were considered disparate based on Healthy People 2020 definitions. Outcomes included: 1) HTN control; 2) blood pressure change; 3) medication adherence; and 4) utilization of care. Multiple databases were searched for published articles from 2000-July 2016 without restrictions on study design, language, location, or outcomes. The search garnered 1766 titles. Following screening, 18 primary studies were included that noted at least one outcome from TH use in disparate people with HTN.
Results: Thirteen randomized control trials, 4 pre-post, and 1 cross-sectional studies were included. Most studies (61%) were conducted in USA. Follow-up varied from 28-730 days and total sample included 14,136 adults. Studies reported disparate populations by social and community context (89%), education (28%), income (33%), health and healthcare (39%), neighborhood and built environment (6%). TH was utilized in primary care including federally qualified health centers, community clinics, rural and urban small practices, homes, or in mixed settings. Most TH interventions were multi-component, included disease monitoring (83.3%), and/or self-management education (55.5%) implemented by nurses, pharmacists, or community health educators. TH used internet (55.5%) and/or phone (61.1%) or text message (22.2%) to deliver healthcare securely. Physicians reviewed reports as needed. Compared to usual care (UC), 14 of 18 studies found improvement in HTN control or reduced blood pressure. Of these, 9 of the 14 reported on HTN control and 3 of the 9 found improved control (p< 0.05). Of the 12 studies reporting on change in blood pressure, 9 found a significant reduction in either SBP or DBP (p<0.05). Eight of the 18 studies reported on hypertension medication adherence and 2 of the 8 studies found a significant improvement in adherence (p<0.05). Frequency of HTN assessment was reported and significantly improved for TH in 2 of 18 studies (p<0.05).
Conclusion: In conclusion, TH showed promise to improve blood pressure control, and other health outcomes in disparate people with HTN. These results may inform healthcare providers, health plans, and decision makers of the potential for TH to improve HTN control among disparate populations.