SummaryPatients with hypertension were given the opportunity to use a personal health record to track their blood pressure, monitor other health data, access educational information, and send secure messages to their physicians. Some patients received a home blood pressure monitor to facilitate blood pressure monitoring; others obtained readings on their own devices or at the doctor’s office, grocery store, or pharmacy, and then manually input the data into the record. Overall use of the personal health record was low and did not lead to improvements in blood pressure; utilization of health services; or patient activation, empowerment, and satisfaction.
Developing OrganizationsGeorgia Health Sciences University
Georgia Health Sciences University and Augusta State University have consolidated and are now known as Georgia Regents University.
Date First Implemented2009
Problem AddressedHypertension, defined as a sustained blood pressure of at least 140 over 90 millimeters of mercury,1 is a prevalent and deadly health problem in the United States. Many hypertensive patients do not have their blood pressure under control. Personal health records (PHRs) can help patients self-manage the condition, but few patients use these tools.
- High prevalence, deadly consequences: Almost 29 percent of the U.S. population has hypertension, with prevalence being higher among women and increasing with age.2 In the United States, hypertension contributes to one of every seven deaths overall and almost one-half of all cardiovascular-related deaths.3
- Largely uncontrolled: Only 18 percent of all hypertensive patients have the condition under control as a result of diet, exercise, or treatment,4 and only 30 percent of those receiving treatment from a primary care physician have the condition under control.5
- Unrealized potential of self-management tools such as PHRs: Because diet and exercise have a measurable impact on blood pressure, self-management represents a critical component of keeping hypertension under control. Tools such as PHRs have the potential to help patients manage the disease, but relatively few patients have access to PHRs, and even when they do, they often do not use them. Research has found that only 7 to 10 percent of patients use PHRs.6
Description of the Innovative ActivityPatients with hypertension were given the opportunity to use a PHR to track their blood pressure, monitor other health data, access educational information, and send secure messages to their physicians. Some patients received a home blood pressure device to facilitate monitoring; others obtained readings on their own monitor or at the doctor’s office, grocery store, or pharmacy, and then manually input the data into the record. Key program elements included the following:
- Identification of eligible patients: A research team reviewed daily patient schedules at two physician practices and identified those patients with controlled or uncontrolled hypertension. After receiving confirmation from the physicians about which patients should be approached about the program, a researcher greeted these preapproved patients in the office before their regularly scheduled office visits and invited them to participate.
- Setting up PHR: The researcher helped interested patients create a user name and password and briefly showed them the various functions of the PHR. During this session, patients learned how to enter and track blood pressure data; send secure messages to clinicians; review information on medications, allergies, and immunizations; access educational information; and set and track goals using a health diary.
- Monitoring and inputting blood pressure data: Additionally, patients in the PHR group were randomly assigned to either receive or not receive a portable blood pressure monitor that would take and track their blood pressure. The portable blood pressure monitor could be linked to a computer, which automatically uploaded the blood pressure readings. Patients who did not receive a monitor could use devices they already owned or manually enter blood pressure readings taken at their physician's office, grocery store, or pharmacy.
References/Related ArticlesWagner PJ, Dias J, Howard S, et al. Personal health records and hypertension control: a randomized trial. J Am Med Inform Assoc. 2012;19(4):626-34. [PubMed]
Wagner P, Stepnowsky C, Ricciardi L, presenters. A National Web Conference on the Evaluation of Personal Health Record (PHR) Systems and Their Impact on Chronic Disease (webinar). January 25, 2012. Available at: http://healthit.ahrq.gov/events/national-web-conference-evaluation-personal-health-record-phr-systems-and-their-impact.
Contact the InnovatorPeggy J. Wagner, PhD
School of Medicine Greenville
University of South Carolina
Healthcare Administration Building (MIP)
701 Grove Road
Greenville, SC 29605
Innovator DisclosuresDr. Wagner reported having no financial interests or business/professional affiliations relevant to the work described in this profile.
ResultsOverall use of the PHR was low and did not lead to improvements in blood pressure; utilization of health services; or patient activation, empowerment, and satisfaction.
- Little use: A 1-year randomized trial involving 24 primary care physicians and 443 patients with hypertension found that only 26 percent of patients used the PHR on a regular basis; those perceiving a high need based on the severity of their hypertension and those with close relationships with their physicians were more likely to use the PHR.
- No meaningful reduction in blood pressure: PHR users did not achieve a significant reduction in blood pressure over time, nor did they achieve reductions compared to nonusers. Only the most frequent PHR users (those accessing the system at least twice a month) achieved a drop in blood pressure, and this reduction tended to be small (a 5.25-point average decline in diastolic blood pressure and a 3.97-point average drop in systolic blood pressure).
- No effect on use of medical services: PHR users and nonusers self-reported similar use of outpatient visits, hospital days, and emergency department visits.
- No impact on patient activation, empowerment, or satisfaction: Compared to nonusers, PHR use did not increase patient activation (i.e., self-reported patient skills, knowledge, and self-management behaviors) or patient empowerment (i.e., patient feelings of control over health), as measured by scores on the 13-item Patient Activation Measure assessment tool7 and the Patient Empowerment Scale.8 Consumer Assessment of Healthcare Providers and Systems survey data found that PHR user satisfaction with the physician, office staff, access to care, and physician communication did not increase over time and did not differ from that of nonusers.
- Do more than give patients access to a PHR: Simply giving patients access to a PHR did not ensure its use. Consequently, physicians, health systems, and researchers must identify the factors that will encourage patients to use information technologies to monitor and improve their health.
- Leverage physician influence: As noted, patients who had a long-term relationship and good communication with their physicians tended to use the PHR more than those who did not. This finding suggests that physicians and their staff can influence PHR use by emphasizing its benefits and the importance of patient involvement in their health more broadly.
- Help patients become comfortable with technology: Patients will be much more likely to use a PHR if they feel capable of and comfortable with doing so. As a result, they need upfront training and ongoing support and encouragement.
- Recognize that use may vary by clinical need: As noted, patients who perceived a high clinical need (e.g., those newly diagnosed and those with severely uncontrolled hypertension) tended to use the PHR more frequently. At the same time, the many hypertensive patients who are asymptomatic may not feel the need to use a PHR to monitor their health.
- Offer mobile technologies if possible: Patients often enjoy using smart phones and other mobile technologies to access applications; hence PHR applications for these technologies may prove to be more appealing.
- Identify best strategies for physicians to incorporate PHR use into practice: Physicians requested help with strategies to incorporate PHR data and results into already busy clinical practices and hectic visits.
Centers for Disease Control and Prevention. Racial/ethnic disparities in prevalence, treatment, and control of hypertension—United States, 1999-2002. MMWR Morb Mortal Wkly Rep. 2005;54(1):7-9. [PubMed]
Centers for Disease Control and Prevention. Vital signs: prevalence, treatment and control of hypertension, United States, 1999-2002 and 2005-2008. MMWR Morb Mortal Wkly Rep. 2011;60:103-8. [PubMed]
Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303(20):2043-50. [PubMed]
Wagner PJ, Dias J, Howard S, et al. Personal health records and hypertension control: a randomized trial. J Am Med Inform Assoc. 2012;19(4):626-34. [PubMed]
Hibbard J, Mahoney ER, Stockard J, et al. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918-30. [PubMed]
Bulsara C, Styles I, Ward AM, et al. The psychometrics of developing the patient empowerment scale. J Psychosoc Oncol. 2006;24(2):1-16. [PubMed]
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Original publication: September 25, 2013.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: September 25, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.