TElemedicine to Replace Face-to-face Physician Consultation in Patients With HyperTension : a Pilot Randomized-controlled Trial

Study Overview
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Brief Summary
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The investigators has developed a blood pressure telemonitoring system. It is hypothesized that, when optimal control of BP is confirmed on the telemonitoring system, the index physician's consultation can be safely deferred, and medications can still be prescribed without such face-to-face consultation. Despite potentially resource-saving for doctors and time-saving for patients, the feasibility and patients' acceptability of the use of the telemonitoring system to replace face-to-face physician consultation remains unclear. For primary outcome, the investigators hypothesize that this telemonitoring system will be feasible and acceptable to patients and can replace physicians' face-to-face consultations. For secondary outcomes, the investigators hypothesize that patients receiving care through telemonitoring have non-inferior BP control when compared with patients receiving usual care. Furthermore, the patients receiving telemonitoring may also have enhanced self-efficacy and compliance to drugs and lifestyle interventions

Official Title
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Safety, Feasibility and Acceptability of Using TElemedicine to Replace Face-to-face Physician Consultation in Patients With HyperTension in Hong Kong: a Pilot Randomized-controlled Trial

Conditions
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Hypertension

Intervention / Treatment
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* Device: telemedicine
* Other: usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: have a diagnosis of essential hypertension (HT) and are currently taking antihypertensive agents have good control of clinic BP as confirmed on ambulatory blood pressure monitoring (ABPM) (daytime BP ≤135/85mmHg) can read basic Chinese (as the content of the app in Chinese) have a home BP monitor (HBPM) used any mobile app (not HT-related) in the previous 1 year Exclusion Criteria: an inability to give informed consent unwillingness to conduct HBPM or repeated ABPM current use of any other HT app for BP monitoring relative contraindications to ABPM (diagnosed atrial fibrillation, occupational drivers or patients with bleeding tendencies) severe mental illness, including those diagnosed with schizophrenia, dementia or as being actively suicidal, because these patients may have diminished ability to use the HT app; a diagnosis of other chronic disease(s) that need regular physical assessments and doctors' consultations (e.g. diabetes and asthma that are being treated, but patients with hypertension and hyperlipidaemia will remain eligible) diagnosed active cancer,

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: telemedicine group<br>The HT app (HealthCap) allows patients to record their home BP measurements (HBPM) and can automatically provide mean BP values from the previous 7 or 30 days. 1-2 week prior to a scheduled physician, HealthCap and a research assistant will remind patients to take dual BP readings both in the morning and evening for 1 week for doctors' management. The mean values of the 7-day home BP will be checked before the index consultation. If the home BP control was optimal (i.e. ≤135/85 mmHg), other important parameters will be checked automatically by a questionnaire in the app: (i) if they have good drug compliance and if they experienced any side effects,(ii) if they have symptoms suggestive of target organ damages such as chest pain or hemiplegia, and (iii) if they have any problem(s) that need to consult a physician. If no complaints are identified, the patient can collect medications directly from the clinic and the physician appointment will be deferred for 3 months | Device: telemedicine<br>* a mobile app and telemedicine platform to confirm good blood pressure control and may save doctor face-to-face consultation<br>Other: usual care<br>* These patients have unrestricted access to healthcare resources such as general outpatient clinics and emergency departments<br>|
| Placebo Comparator: usual care<br>Patients in the usual care group will be asked to refrain from downloading or using any health care apps related to HT | Other: usual care<br>* These patients have unrestricted access to healthcare resources such as general outpatient clinics and emergency departments<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| rate of recruitment | number of patients recruited per month during the recruitment period | baseline | 
| rate of retention | number of dropouts during the 6-month study period | baseline, 6-month | 
| acceptability | interview of around 20 patients in the intervention group | at 6-month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| blood pressure levels on 24-hour ambulatory blood pressure | daytime, nighttime, and 24-hour systolic and diastolic blood pressure | baseline, 6-month | 
| healthcare utilization | number of visits to general outpatient clinic, specialist clinic(s) and hospitalization during study period | 6-month | 
| self-efficacy scale | 5-item self-efficacy scale specific to hypertension; a mean score from the items of a 9 or above were classified as having good self-efficacy | baseline, 6-month | 
| medication and diet adherence | Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); Score was summed to give a total range, higher score represented better adherence | baseline, 6-month | 
| exercise level | Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ); higher scores represented higher exercise level | baseline, 6-month | 
| eHealth literacy | Chinese 8-item eHealth literacy scale; higher scores represented higher eHealth literacy | baseline, 6-month | 
| health literacy | 3-item Brief Health Literacy; higher scores represented higher health literacy | baseline, 6-month |