IFAS and CAST collaborate on hypertension study of kiosks

A unique research partnership between AAHSA’s Institute for the Future of Aging Services (IFAS) and its Center for Aging Services Technologies (CAST) could eventually help low-income older people use community-based technologies to better manage their hypertension. 

The partnership grew out of previous studies showing that people who monitor their blood pressure at home are better able to understand and control their hypertension. Unfortunately, says Dr. Helaine Resnick, director of research at IFAS, home-based monitoring may not work well for low-income older people with low health literacy, who may not be able to afford monitoring equipment and may not have access to health professionals with whom they could discuss abnormal readings.

Using funds from the Agency for Healthcare Research and Quality (AHRQ), IFAS and CAST are currently working on a small pilot study to test what could turn out to be a better approach. That approach places a blood pressure monitoring device in a public place that older people visit on a regular basis, trains those individuals to take their own blood pressure once a week, tracks blood pressure readings through an electronic database and provides a support network of health professionals to help older people understand and manage their condition.

The hypertension study, which began on July 1, will include 144 older people who suffer from hypertension, have a primary care physician and regularly attend one of four community-based senior nutrition centers in west central Ohio. Seventy-two participants enrolled at two intervention sites will use a table-top telehealth blood pressure station to record and transmit their blood pressure each week. Another 72 nutrition center clients in two control sites will not use the telehealth blood pressure station.

In addition to Resnick, the research team includes Dr. Majd Alwan, director of CAST, and Dr. Pramod Gaur, president and CEO of Healthanywhere, Inc., an Ottawa, Canada-based eHealth technology company and CAST member that donated the technology being used in the project. A team of three nurse researchers from Wright State University in Dayton, Ohio are managing the field work for the project at the nutrition centers. They are: Dr. Perla R. Ilagan and Dr. Mary Beth Kaylor, both assistant professors in WSU’s College of Nursing and Health, and Diane Mehling, a certified research project coordinator who is assistant director of The Nursing Institute of West Central Ohio.

Creating a Health Network

During the enrollment process at the intervention sites, nurse researchers working under Mehling’s direction sit down with each study participant to conduct a general health questionnaire and create an electronic personal health record that will store 10 months worth of blood pressure readings. Nurse researchers also contact each participant’s primary care physician, who identifies a blood pressure level that is normal for the individual and provides customized protocols that nurses will follow when blood pressure readings exceed that level.

Each week, study participants use a personalized “smart card” to sign into the kiosk provided by Healthanywhere. Using a Bluetooth-enabled monitor, they take their blood pressure reading, which is sent first to the kiosk and then, via a broadband Internet connection, to a secure database maintained by Healthanywhere. When a higher-than-normal blood pressure reading reaches the database, it automatically sends an alert e-mail to Ilagan and Kaylor, who call the individual to relay the physician’s pre-ordained instructions. In addition, every study participant talks with either Ilagan or Kaylor on a bimonthly basis to report any recent blood pressure-related doctor visits, emergency room trips or hospitalizations.

“We will have a close relationship with these people for 10 months,” says Ilagan. “It is not like other research projects where you gather the information upon enrollment and you don’t talk to them anymore.”

Narrow Research Questions

Despite the research team’s attention to detail in designing its intervention, the hypertension project will not actually measure whether, in the end, participants are better able to manage their hypertension. Instead, AHRQ is looking for a “proof of concept” showing that the research team was able to establish a workable infrastructure to carry out the intervention it designed.

“We need to show that we can get nutrition centers and doctors to work with us and that we can teach older people and nurse researchers to use the technology,” says Resnick. “In the end, we should also be able to tell AHRQ whether this approach is sufficiently promising to warrant a larger clinical trial.”

Alwan and Gaur are eager to learn how comfortable study participants feel when using the high-tech kiosks and how easily nurse researchers can create and access participants’ personal health records.

“The technology must be user-friendly for both providers and patients or they will not continue to use it over the long term,” says Gaur. “We are trying to design something that is going to become part of their lifestyle.”

As director of CAST, Alwan would ultimately like to see the widespread acceptance and use of aging services technologies. He remains hopeful that the more user-friendly telehealth becomes, the more likely AAHSA providers will be to deploy technological devices like the blood pressure monitoring kiosk in their own communities.

“We believe that telehealth technologies can allow providers to deliver a new set of services out into the community, outside of the bricks and mortar of their facilities,” says Alwan. “That’s where the majority of seniors would prefer to be and that’s where pioneering AAHSA providers are looking to play a role. And that’s where we expect it to be most cost effective to manage chronic conditions and reduce unnecessary hospitalizations.”

Technology’s ability to facilitate community-based care for older people also appeals to Kaylor, who has a background in public health nursing. 

“Ultimately, this project is about empowering people so they can live longer, healthier lives,” she says.