For Hypertension Patients, Virtual Visits Might Be as Effective as In-Person Care

Last month, researchers from Brigham and Women’s Hospital and Harvard Medical School published what they considered the first ever trial to gauge the effectiveness of a standalone mHealth prescription adherence app for hypertension. The results were somewhat underwhelming: Patients in the mHealth group did just as well as the controls who weren’t using any special reminder system.

But researchers from Brigham and Women’s have just published another study examining digital interventions for hypertension. And in this case, achieving the similar outcomes between the test and control groups was an indisputably positive outcome—and by some metrics the virtual care group performed even better.

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Collaborating this time with their neighbors at Massachusetts General Hospital, the team wanted to see whether “virtual visits” for hypertension patients provided the same benefits as in-person follow-ups. They weren’t looking at, say, video chats or phone calls, but rather non-simultaneous communication: Patients checked in with their primary care doctors by reporting their care metrics (up to 5 blood pressure readings between visits) and needs through a secure website, which the physicians can check at a later time and use to shape ongoing care.

Massachusetts General has been offering the option for almost 6 years now. The new study tracked outcomes data from December 2012 until February 2016, comparing 893 patients who used the virtual with 893 Brigham and Women’s patients who did not. The 2 groups entered the study period with similar blood pressure readings—and while both groups improved their blood pressure by the end of the study period, they did so whether they communicated with their doctors digitally or in person.

Those in the virtual group, however, average 0.8 fewer follow-up office visits. That’s encouraging, according to the researchers. David Michael Levine, MD, lead author on the study, said that the findings underscore the ways that digital tools can be used to alleviate some of the burden on busy primary care practices. The work could also be a bit of evidence for unconvinced stakeholders to mull over.

“Many groups, especially insurance companies, have been skeptical of virtual care because they believe it may increase the use of health care services,” Levine said. “But our findings show that a virtual visit can substitute for, rather than add to, an in-person visit, decreasing overall health care utilization."

That’s key, the researchers said, because of the well-known travel and cost problems that physical visits can present to patients with chronic conditions. Co-author Ronald Dixon, MD, of Massachusetts General cited a previous paper he had worked on, which showed that conducting and documenting a virtual visit takes physicians about a fifth of the time that doing the same for an in-person appointment does.

The research “also supports scaling this concept to other chronic diseases with the addition of devices allowing collection of needed patient information,” he said. Currently, the hospital system uses the virtual visit model for follow-ups in more than 60 chronic conditions, and the practice is being expanded to Brigham and Women’s Hospital and other centers in the network.

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