Telemedicine Use and Hypertension Control in an Urban Community Health Center Cohort.

Abstract

Background: Real-time or synchronous telemedicine can be a valuable adjunctive strategy for chronic disease management, but few studies have assessed its impact on hypertension control among safety-net populations.

Objective: To evaluate whether telemedicine is associated with blood pressure (BP) control.

Design: Retrospective cohort study. Mixed-effects logistic regression models clustered by the patient estimated associations between telemedicine and BP control after adjusting for patient factors and neighborhood context.

Participants: Patients seeking care at an urban, multisite community health center with hypertension and ≥1 BP measurement between 2020 and 2022 (3663 patient-year observations across 2086 unique patients).

Main measures: The primary outcome was BP control defined as a binary variable. We used the Centers for Medicare & Medicaid Services' Controlling High Blood Pressure quality measure criteria of systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in the most recent recording in the measurement year.

Key results: Among the 2086 patients with hypertension in our sample, there were 1257 (60.3%) Latinx and 425 (20.4%) Black patients. Over 90% lived in a neighborhood of high deprivation as categorized by the social deprivation index. Telemedicine visits, compared to none, were not associated with blood pressure control (1-2 telemedicine visits aOR, 1.05 [95% CI, 0.86-1.28]; ≥3 telemedicine visits aOR, 0.86 [95% CI, 0.68-1.09]). One in-person visit per year, compared to 2-3, was associated with lower odds of BP control (aOR, 0.72 [95% CI, 0.55-0.94]). Black patients, compared to Latinx patients, were less likely of having BP control (aOR, 0.64 [95% CI, 0.48-0.87]).

Conclusions: In this community health center cohort of patients with hypertension, telemedicine did not compromise blood pressure control. Persistent racial disparities in blood pressure control underscore the need for equity-centered strategies for hypertension management in safety-net primary care settings.