Use of Cellular-Enabled Remote Patient Monitoring Device for Hypertension Management in Pregnant Women: A Feasibility Study

Maternal and Child Health Journal https://doi.org/10.1007/s10995-023-03628-1 Use of Cellular-Enabled Remote Patient Monitoring Device for Hypertension Management in Pregnant Women: A Feasibility Study Rebecca D. Jones1 · M. Kathryn Allison1 · Heather Moody1 · Cheng Peng1 · Hari Eswaran1 Accepted: 15 February 2023 © The Author(s) 2023 Abstract Introduction Hypertension affects 5–10% of pregnancies in the United States. Chronic hypertension during pregnancy can have a significant impact on maternal and neonatal outcomes, especially in rural populations. Pregnancies complicated by hypertension are currently managed through frequent clinic visits or extended hospital stays. Cellular-enabled remote patient monitoring devices provide an alternative treatment method for women in rural areas. Research Aim This study aimed to measure the feasibility of and patient satisfaction with using an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. Methods In a mixed methods pilot study, twelve women with chronic hypertension during pregnancy were given cellularenabled BodyTrace™ blood pressure cuffs and weight scales. Participants’ blood pressures were continuously monitored by a nurse call center. Participants completed a survey and a brief semi-structured interview after two weeks. Results Participants scored low on stress and anxiety with mean scores of 5.45 (SD = 3.56) and 8.09 (SD 3.62), respectively. Participants scored high on behavioral intention, system usability, and perceived benefits with mean scores of 8.73 (SD = 2.53), 75.91 (SD = 23.70), and 19.64 (SD = 5.92), respectively. Participants perceived benefits to using the device, including increased monitoring by health professionals, increased self-awareness, decreased number of clinic visits, and convenience of use. Perceived disadvantages included higher readings when compared to clinical readings. Discussion Cellular-enabled remote patient monitoring devices for blood pressure are a valuable tool for managing treatment of pregnancies complicated by hypertension. Significance Previous research on remote patient monitoring (RPM) for hypertension management in postpartum and pregnant women found high participant satisfaction, decrease in blood pressure (BP) rates, increased BP management, and overall positive perceptions. This is the first study to assess the feasibility and acceptability of cellular-enabled RPM BP devices, which do not require a smartphone or app, combined with a 24/7 nurse call center with continuous BP monitoring and response to high readings for better care management. This mixed-method study explored patient satisfaction with the integrated BP system and perceived advantages and disadvantages of the device. Keywords Remote patient monitoring · Cellular-enabled remote patient monitoring device · Hypertension · Pregnancy · Pregnant women Introduction Rebecca D. Jones MPH 1 University of Arkansas for Medical Sciences, 4301 West Markham Street Little Rock, Little Rock, AR 72223, USA Healthcare disparities are prevalent in obstetrical care in the United States (US), impacting more than 27 million women and infants and leading to significant resource and financial burdens for rural states (Rural Health Information Hub, 13 Maternal and Child Health Journal 2019). Academic health science centers typically provide the only referral source for high-risk pregnancies in rural states, and many of these women travel several hours for prenatal visits (Rhoads, 2017). In addition to financial and geographical burdens, these women experience treatment delays which further compromise their health outcomes. Telecommunication technologies, such as remote patient monitoring (RPM), can support and promote long-distance clinical health care by enhancing quality of care, reducing costly readmissions and emergency department visits, and keeping costs manageable for small, rural hospitals (Lustig, 2012). Management of chronic conditions during pregnancy, such as hypertension, can have a significant impact on optimal maternal and neonatal outcomes, especially in rural populations (Hansen & Moloney, 2020; Fingar et al., 2018). Hypertension during pregnancy, a common indicator of preeclampsia, is a major health concern for women and their newborns—not only in the US, but worldwide (MagroMalossa et al., 2017, Magee et al., 2014, Hypertension in Pregnancy, 2013). The incidence of hypertension in pregnancy has increased by 25% in the past two decades, currently affecting 5–10% of all pregnancies in the US (Ananth et al., 2013, Lo, Mission, & Caughey, 2013). This has disproportionately affected minority women and women living in rural areas (Howell et al., 2017; Lisonkova et al., 2016, & Creanga et al., 2014). Both in Arkansas and nationally, maternal death rates are higher for racial minorities and socioeconomically disadvantaged populations (Lanssens et al., 2018). Early identification of hypertension or preeclampsia can help minimize hospitalizations, reduce morbidity and longterm healthcare costs, and improve maternal outcomes. The current standard of care for management of pregnancies complicated by hypertension is close monitoring through frequent clinic visits or hospitalization until delivery. However, RPM offers an alternative solution for patient management in rural, low-health resource settings. The use of cellular-enabled blood pressure (BP) devices can be an effective tool in providing physicians the physiological data necessary to more accurately track and respond to patient’s BP readings thus allowing a reduction in the number of clinic visits for patients, especially those living in rural areas where frequent trips to the doctor’s office may not be feasible. Instant access to data also allows physicians the ability to address concerns between patient visits, leading to better health outcomes for both the woman and infant. The ability to monitor BP readings for pregnant women with a history of hypertension or preeclampsia is imperative for improved health outcomes. 13 Purpose This study aimed to measure patients’ satisfaction with and feasibility of using an integrated model of cellular-enabled RPM devices for BP supported by a 24/7 nurse call center. Methods Study Design This study was a mixed methods pilot study utilizing a survey and brief semi-structured qualitative interview to assess the feasibility and acceptability of RPM BP devices supported by a nurse call center for pregnancies complicated by hypertension. Twelve women identified as having a history of chronic hypertension were invited to participate in this study. Participants were given a cellular-enabled BodyTrace™ kit that included a BP cuff and weight scale for home use according to their healthcare providers’ recommendation. While the weight scale was provided as part of a kit from BodyTrace™, this paper is solely focused on the BP monitors, and weight data was (...truncated)