Introduction

Hypertension is a health condition that is described by a blood pressure equal to or higher than 140/90 mmHg (Dougherty and Lister 2015). The condition causes premature mortality and morbidity as it increases the risk of developing cardiovascular and renal disease which is preventable.    About 42% of the adult population in England is affected by hypertension. The National Health Service (NHS) faces a financial challenge in managing hypertension as it yearly costs the department over £42 billion (Dougherty and Lister 2019). The diagnosis of hypertension through primary healthcare can lead to significant cost savings on funds used in later management and treatment of the condition.

Despite the adverse health consequences associated with the condition, its management and control is inadequate. Patients compliance with treatment regimens possess a hindrance in managing the condition, noncompliance may be either intentional or unintentional. Mainly, unintentional factors lead patient to not adhering to medication due to issues such as misconception or lack of understanding about the medication. Telehealth is a significant development in healthcare which supports the management of hypertension. As such, it is increasingly being integrated into the National Health Service. The system implies many varied technologies that support the delivery of healthcare

Aim

The purpose of this paper is to examine telehealth usage in hypertension management. In so doing, it will identify the evidence which demonstrates the impact of telehealth in hypertension management.

Method

A database search was conducted to find articles that meet the search criteria for the study. The data bases searched include PsychINFO, EMBASE, CINAHL, ProQuest, and PubMed. The search included articles written from 1997 to the present time and which discussed the impact of telehealth in monitoring hypertension and BP control. The search produced fifteen articles which met the search criteria. It was found that blood pressure reduced with the use of telemonitoring technology for all studies apart from two which gave different results. The search focused on hypertension management using telemedicine and all the searched articles were reviewed to ascertain that they discussed the issue under study. Different articles were compared to decide their inclusion in the study. The basis of including papers was based on their discussion of the effectiveness of using telehealth in hypertension management as well as the facilitators and barriers to the management of the condition. Search terms used to obtain the papers include telehealth, hypertension, information technology, blood pressure, elevated blood pressure, ehealth, and telemedicine.

The only papers that were included are academic journals that were in English. From the articles exploration, several; issues relating to the matter were identified. They are as follows:

The role of the patient in using telehealth to manage hypertension

Costs associated with the telehealth system

The position of healthcare providers in telehealth use.

The effectiveness of the system in managing hypertension

Findings

The role of the patient in using telehealth to manage hypertension

While hypertension is a common condition affecting many people in the UK. Its management by patients is not fully efficient especially in the absence of a healthcare provider. When home care lacks a proper follow through, the disease may need to be managed through a telehealth system. The strategy is important for it allows the patent to be actively involved in managing their illness. The patient plays a critical role in telehealth application since the system enables them to enhance the communication with the healthcare team making monitoring efficient even when at home. As such, the physician can improve the healthcare outcomes when the patient is actively involved in their health management.

Telehealth is a remote health technology making its way in modern medicine by making the patient more involved. Consultation time and costs is reduced through the system since patients can make contact with their healthcare provider from their homes, they can be monitored and conveniently communicate without the need to physical contact. A patient spends less time seeking physical consultation and they can utilize the time to undertake more meaningful activities in their life.

It is important that hypertension patients make regular hospital visits as it is critical for their treatment. There is great danger in failure to properly monitor the condition. The rate of blood pressure can gradually increase and this can cause fatal health consequences. So, patients are expected to make sure they make regular hospital visits. However, this is not always possible as sometimes patients may face barriers that inhibits their access healthcare. Social barriers may acts as constrains that limit healthcare access, therefore, telemedicine plays a critical role in ensuring that patients access the required services. Patients that face the barriers to healthcare can engage with telehealth services to receive the necessary services. Given that emergency and inpatient costs may be very high, telehealth services are valuable since consultations can be easily made.

Patients applying telehealth services are found to record a significant improvement in controlling their blood pressure in comparison to those who do not apply the strategy. Additionally, there is noteworthy decline in blood pressure among patients that receive healthcare support through telehealth technology. Telehealth services were found to improve patient self-management of hypertension. Through the system, patients are able to self-monitor their condition, the healthcare provider is also able to give the patient frequent warning reminders depending on the state of their health as described by collected data (Lu, Chen and Hsu, 2017 p.9). The study by Lu, Chen and Hsu, (2017) demonstrated that attaining BP control was easier for patients that frequently employ the telehealth services to conduct self-monitoring. Continued use of the system results to gradual stabilization of blood pressure over time. Additionally, given that the telehealth equipment generates warning reminders of the level of blood pressure, the patient is motivated to focus on controlling their blood pressure. On the other hand, the lack of a warning may lead a patient to not caring about health as they may not be aware of an increased BP. Therefore health information transmission is an important part of telehealth and serves to benefit the patient. They become more engaged as they work on controlling their condition based on available and reliable information. A patient can take up a more active role as the information enhances self-awareness and helps them to gain a deeper understanding of their condition hence enabling disease self-management. Self-management is a complex activity and support with information is crucial in ensuring that efficacy is obtained in controlling hypertension.

Thus, it is observable that the telehealth services allow patients to take up a more self-management role in controlling hypertension. By integrating the system with conventional healthcare services, better healthcare outcomes are achieved as managing medical conditions is enhanced. The system also reinforces positive patient behavior as the health information provided is key in shaping their conduct.

Nevertheless, elderly patients are expected to demonstrate reduced efficacy in hypertension self-management when using telehealth equipment. Due to technical reasons, cognitive and physical deficiencies, older patients face problems in correct use of devices. However, research demonstrates that elderly patients report greater efficacy in issues related to self-management of their health condition. They also report that they benefit from relating with a healthcare provider through the telehealth system by providing them with information about their health where in return they receive support and feedback on their condition. Also, elderly patients consider telehealth to be beneficial to them by allowing them to understand and control their condition. Hence, even if the device possess a challenge to them, they still feel motivated to manage their condition which is very essential for achieving desired health outcomes.

With regards to the role of the patient, it can be concluded that by allowing patients to participate in disease management, effective blood pressure control is attained. Self-management is also more efficient as telehealth devices provide health information which guide hypertension patients in providing self-care. The effectiveness of the technology cannot be underestimated since it not only ensures efficacy in disease management but it also saves costs. Patients do not have to arrange for physical visits with the physicians. Hence, there is a significant role played by patients in the use of telehealth technology, its success can be majorly attributed to the correct use of the devices by hypertension patients.

Costs associated with the telehealth system

Telehealth systems are associated with reduced healthcare costs. The use of the technology is considered cost effective especially now that technology has become cheap. The practice is affordable, effective, and efficient in serving the intended population. Therefore, the economic gain from the technology is expected. It provides many avenues for reducing the cost of health care as the overall cost of caring for hypertension patients is observed to reduce in the long-run. The health care cost per person seems to remain the same in the short run. However, after a long period of using the intervention, the economic value of the system is observable. Reducing the number of visits the patients make to the hospital serves to reduce healthcare bills as physicians are able to cater for other health concern while still electronically monitoring other patients at home. It saves a lot of time as it allows data collection which is processed to produce useful information to guide the patient in self-management. With readily available information, telehealth allows patients to receive warning and therefore mitigate healthcare problems that are likely to occur. As such, the systems works to prevent the occurrence of emergencies and consequently emergency visits that would otherwise result to additional costs.

The costs effectiveness is considered underestimated given that maintain the system is les expensive due to the decreased costs of technology. Therefore, using eHealth devices does not cost the healthcare system a lot of money and the benefits associated with the technology exceed the disadvantages by far. Additionally, any additional cost associated with self-management using telehealth is also linked to better quality of life for hypertension patients. So as much as the costs may be higher, the corresponding quality of life is significant as it shows reduced possibility of cardiovascular health problems which would costs a lot of money. The prevention of such adverse health events translates to savings on costs that would have been spent to care for the patient if they did not attain quality life through self-management. Therefore, any notable increase in costs corresponds to a better health outcome that would otherwise bear a greater financial cost.

Over the years since the conception of telehealth, numerous studies have provided sufficient findings to support the cost effectiveness of the system. Over the years the cost of telehealth services has declined and so the system is definitely improving to be more cost effective (McKoy et al., 2015). With technology expected to continue developing, telehealth is also expected to grow and become for affordable and efficient. Therefore, it is a system that is promising to the healthcare fraternity and its adoption is a significant way of catering for healthcare costs reductions now and in the future. Telehealth is found to be effective in monitoring hypertension from home and it is one of the interventions that reduce care costs for patients.

In a study conducted by Kaambwa et al. (2014) data from randomized controlled trials of studies discussing hypertension self-management was collected and analyzed. The studies provided extensive data as the research entailed high levels of follow-up and data collection. The evidence provided in the study is sufficient as the Markov model was applied to eliminate errors connected to within trial analyses. The outcomes from the study show that the concept of self-monitoring in both men and women is cost effective in comparison to the conventional method of hypertension management and care. In quality adjusted life year, policy makers are ready to up to £1600 and £4900 for men and women respectively (Kaambwa et al. 2014 p.1525). The stated cost is within the cost effectiveness principles utilized in the United Kingdom. Therefore, based on the model applied in the study by Kaambwa et al. (2014) the economic value obtained from use of self-monitoring devices is sufficient irrespective of the gender. Particularly, greater value is gained in the long term use. Other than the costs, quality healthcare outcomes such as reduced blood pressure accompanies the effectiveness of the system. With regards to cost reduction, hypertension management through a telehealth system represents a new management and monitoring system that ensures efficiency and is affordable. Hence the new development that the healthcare industry must seek to continue developing.

The effectiveness of the system in managing hypertension

The effectiveness of using telehealth in managing hypertension is significant as studies demonstrate the usefulness on the system in improving healthcare outcomes. Cottrell, Chambers and O’Connell, (2015) conduct a study to assess the effectiveness of the strategy. They identify that for patients conducting self-management through the system, their blood pressure significantly declined in comparison with the control group. The decline was informed by the high number of blood pressure readings which could have been as a result of numerous changes in antihypertensive medications which was facilitated by the system, the recording of BP values on time, improved patient awareness about the value and significance of their blood pressure measurement.

Conclusion