Innovative Telemedicine Program Allows New Moms to Monitor Hypertension at Home
Oct 31, 2019 01:45PM
● By Vanessa Orr
When Stephanie Schagrin’s baby was born at 31 weeks and was placed in the neonatal intensive care unit (NICU), her attention was focused on being there for her child. The last thing she was concerned about was her own health.
“I was diagnosed with hypertension after the baby’s birth, but I had so much on my mind as a new parent that I never thought of my blood pressure at all,” she explained. “I’m a nurse, and I know how detrimental high blood pressure can be, especially when you don’t have any signs or symptoms. It can result in a stroke or other issues, and it’s not to be taken lightly at all.”
Fortunately, Schagrin was enrolled in an innovative blood pressure home-monitoring program created by the University of Pittsburgh’s School of Medicine and the Magee-Womens Research Institute (MWRI). The program, which was developed in response to the fact that America has the highest maternal mortality rate in the developed world, with cardiovascular disease as its primary cause, detects concerning trends in postpartum women before their situations can become critical.
“Because the home monitoring program provides daily text prompts to remind you to take your blood pressure, it reeled me back in,” said Schagrin. “It reminded me that I also needed to take care of myself.”
Between February 2018 and October 2019, the program enrolled more than 1,000 women with preeclampsia, eclampsia or chronic, gestational or postpartum hypertension. Each woman is discharged from the postpartum unit with an automatic blood pressure cuff and instructions on how to take their own readings at home. Patients are prompted via text to take their blood pressure and heart rate readings for up to six weeks following their babies’ births.
“My blood pressure was pretty significantly above my baseline when I left the hospital, so I tested it more frequently at the beginning of the program,” said Schagrin, adding that in addition to taking her heart rate and blood pressure, she was also required to answer a few questions about whether she had any symptoms, and how she was feeling in general.
“If there’s something abnormal, the nurses at the call center or your doctor calls you or prompts you to test your levels more frequently,” she added. “It was nice to know that someone was watching what was going on.” In some cases, physicians may also prescribe or change medications, or direct a patient to the emergency department if numbers are critically high.
According to Alisse Hauspurg, MD, assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh, there are numerous benefits for new mothers using the home monitoring program.
“For many women who have high blood pressure when they are pregnant, it may get worse after delivery, which results in morbidity in the postpartum period after discharge from the hospital,” she explained. “The standard of care is for women to be seen in their physician’s office a week after birth to have their blood pressure checked, and seen again for a routine checkup four to six weeks postpartum.
“Many women find this very challenging,” she continued. “Whether they are just home from the hospital with a new baby, or have a baby in the NICU, or have had a C-section and are recovering from major surgery, getting to the physician’s office is difficult.”
To this end, the monitoring program was designed to make care more accessible, and to help new moms become empowered to take the lead in their own healthcare. And it’s working—overall, 83 percent of participants continued the program beyond three weeks postpartum, and 74 percent continued it for four weeks or more. If readings are normal, the one-week follow-up appointment is automatically cancelled, which was the case for 43 percent of women in the program.
“It’s a relief to be able to get back to a sort-of-normal life, and not have to go to the doctor’s office or stay in the hospital because of high blood pressure,” said Schagrin. “My blood pressure is pretty much back to baseline, though it took almost five weeks to come down to normal.”
According to Dr. Hauspurg, one reason for the success of the program is that it is meeting women where they are. “We’re not making them jump through hoops—packing up a new baby and making them come to the office even though they’re feeling fine. We’ve empowered them to monitor themselves and to take control over their health, which is also contributing to higher patient satisfaction.”
Of the 250 women who filled out a post-program survey, 94 percent said that they were satisfied with the experience, and 82 percent said that they were more comfortable knowing that a nurse was checking on their health every day.
Because the monitoring program is linked with each woman’s electronic medical record, it also makes it easy for her primary care physician and other key health care providers to have access to this information.
“High blood pressure in pregnancy coincides with a higher risk of heart disease, stroke, and lifelong high blood pressure outside of pregnancy, so it’s important to make sure that these patients schedule the appropriate follow-ups with their PCPs,” said Dr. Hauspurg.
While nationally, only about 66 percent of new mothers diagnosed with hypertensive disorder make it back for their six-week follow-up visit, for women within the program, that number is 88 percent.
“I believe it is because these women are engaged and involved in their care, and also have more constant communication with the healthcare system,” said Dr. Hauspurg, adding that the follow-up visit is scheduled when patients are enrolled in the program, and texts are sent to remind them.
According to Dr. Hauspurg, in the future, more women may have the opportunity to participate in this telemedicine program.
“We’ve had quite a few places ask us about rolling it out to other hospitals, and that is a possibility,” she said. “While this program is only at UPMC Magee-Womens Hospital right now, we’re hoping in the future to deploy it throughout the UPMC system.”