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Remote Surveillance of Postpartum Hypertension (TextBP)

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ClinicalTrials.gov Identifier: NCT03185455
Recruitment Status : Completed
First Posted : June 14, 2017
Last Update Posted : June 14, 2017
Sponsor:
Information provided by (Responsible Party):
University of Pennsylvania

Brief Summary:
Women with hypertensive disorders of pregnancy need postpartum blood pressure (BP) surveillance to detect persistent hypertension. Various barriers result in only 30% attendance at postpartum BP visits. A more effective strategy is needed. Women with hypertension of pregnancy will be randomized to either text-based monitoring or office visits. Those randomized to the intervention will receive a BP cuff and text in their BP to an automated, clinician derived, HIPAA compliant text-based algorithm.

Condition or disease Intervention/treatment Phase
Hypertension in Pregnancy Other: Remote (text based) surveillance Not Applicable

Detailed Description:

Hypertension is a leading cause of maternal morbidity, mortality and obstetrical readmissions. Peak blood pressure usually occurs 3-6 days postpartum, and is typically unaccompanied by warning symptoms. Although there is a clear need for effective and reliable blood pressure surveillance after delivery, there are significant obstacles to in-person visits in the immediate postpartum period, including sleep deprivation, newborn care, and transportation needs. These barriers have proven real as we observed only 30-50% attendance to office blood pressure visits following delivery. This proposal will investigate whether text-based communication between patients and providers is an effective alternative method for monitoring postpartum hypertension in at risk women.

Women with hypertensive disorders of pregnancy with access to a cell phone with unlimited text message capabilities will be randomized to either office visit blood pressure checks after discharge or receive a blood pressure cuff and text in blood pressures for two weeks postpartum using a standardized, HIPAA compliant, physician derived automated platform.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 206 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The study will be a randomized, two arm trial. Patient will be randomized to usual one time office visit based blood pressure check or to text-message based remote surveillance for two weeks. Randomization will be performed using a computer generated sequence using REDCAP. Demographic information will be collected from those who decline randomization or are ineligible in order to assess patient characteristics of those willing to be randomized and who meet eligibility.
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Remote Surveillance of Postpartum Hypertension
Actual Study Start Date : August 22, 2016
Actual Primary Completion Date : January 20, 2017
Actual Study Completion Date : January 23, 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Postpartum Care
U.S. FDA Resources

Arm Intervention/treatment
No Intervention: Standard of Care
Those randomized to the standard protocol for blood pressure monitoring will be scheduled for an office based nursing blood pressure visits 4-6 days postpartum. Care at this visit is based on a physician derived algorithm.
Experimental: Remote (text based) surveillance
Those randomized to remote surveillance will be provided with electronic blood pressure monitors prior to discharge and instructed on their use. Every day, for two weeks post-discharge, patients will receive a standard text message in the morning from a HIPAA compliant automated monitoring system reminding them to text their blood pressure. They will be asked to send in one blood pressure a day at minimum. They may be asked to send in more depending on the blood pressure result and clinical algorithm. This system will provide timely responses to patient texts and create a physician derived response to elevated blood pressures based on a programmed algorithm. Additionally, for blood pressures that reach a dangerous threshold, a clinical provider will be alerted per the algorithm and contact the patient for further evaluation.
Other: Remote (text based) surveillance
Women with hypertensive disorders of pregnancy with access to a cell phone with unlimited text message capabilities will be randomized to either office visit blood pressure checks after discharge or receive a blood pressure cuff and text in blood pressures for two weeks postpartum using a standardized, HIPAA compliant, physician derived automated platform.



Primary Outcome Measures :
  1. Patient Engagement [ Time Frame: 7-10 days postpartum ]
    The primary outcome is patient engagement, defined as the percentage of patients in which a blood pressure is obtained at 7-10 days postpartum, in accordance with American College of Obstetrician and Gynecologist recommendations, using office based visits and remote text message surveillance among women with preeclampsia.


Secondary Outcome Measures :
  1. Antihypertensive medication [ Time Frame: 2 weeks postpartum ]
    Ability of providers to initiate antihypertensive medication

  2. Number ER visits [ Time Frame: 2 weeks postpartum ]
    number of postpartum emergency room visits for hypertension and readmissions for persistent postpartum hypertension

  3. Patient satisfaction [ Time Frame: 2 weeks postpartum ]
    Patient satisfaction with blood pressure surveillance (measured by exit satisfaction survey)

  4. Change in cardiovascular health [ Time Frame: 2 weeks postpartum ]
    Change in cardiovascular health (measure using the standard AHA 7 and Cardiovascular Health Score) from baseline to study conclusion

  5. Future health awareness/patient engagement [ Time Frame: 2 weeks postpartum ]
    Future health awareness/patient engagement by assessing number of patients with a primary care/cardiology appointment scheduled by two weeks postpartum

  6. Cost data [ Time Frame: 2 weeks postpartum ]
    Cost data will be compared between the two arms.



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Women with chronic hypertension, gestational hypertension, or preeclampsia who deliver at HUP will be eligible to participate. All patients must be > 18 years old, able to speak and read English, have a hypertension diagnosis, and have access to a cell phone with unlimited text message capabilities.

Exclusion Criteria:

  • Women without access to a cell phone with unlimited text message capabilities will be excluded from the study in order to eliminate barriers to participate in remote surveillance. However, we will track the number of women not eligible for this reason in order to understand generalizability in an urban population.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03185455


Locations
United States, Pennsylvania
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
University of Pennsylvania

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT03185455     History of Changes
Other Study ID Numbers: 825390
First Posted: June 14, 2017    Key Record Dates
Last Update Posted: June 14, 2017
Last Verified: June 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University of Pennsylvania:
Hypertension
Pregnancy
Text

Additional relevant MeSH terms:
Hypertension
Hypertension, Pregnancy-Induced
Pre-Eclampsia
Vascular Diseases
Cardiovascular Diseases
Pregnancy Complications