Hypertension is one of the chronic illnesses whose presence within the communities in the last one decade has been significantly felt. The morbidities, mortalities and costs incurred in management and treatment are issues that have impacted on individuals, families and communities (Ferdinand, 2013). Within the US, there are significant disparities especially from a racial perspective in the cases of hypertension. As at present, it is estimated that 41% of African Americans have hypertension which is a high figure as compared to the 27% of Whites who have hypertension (Flack, Nasser & Levy, 2011). Further, up to 28% of African Americans are at risk of being overweight while up to 33% of the African American population is obese (Flack, Nasser & Levy, 2011).
Apparently these are risk factors for the development of hypertension. In a further analysis, these disparities have been found to have a link with the social and economic factors within which these populations survive. The African Americans have been described as indicating higher rates of unemployment as well as higher rates of poverty while the infrastructural and social amenities available for them are not sufficient to sustain a healthy life (Ferdinand, 2013). On the other hand, there is an apparent knowledge gap that has limited the ability of this group to optimally utilize the available resources to support a healthy life (Flack, Nasser & Levy, 2011).
Within the knowledge that hypertension can be managed well and afford the individual a normal life, this concept has not worked well for majority of African American groups who have been diagnosed with this condition. This has led to poor outcomes even after medication and treatment. Such issues can be associated with the lack of adherence to medication and treatment plans. The integration of telemonitoring as a method for keeping track of the patient’s health and enhancing their self-care and self-management techniques has however been hailed in some quarters as a method that can facilitate adherence to medication and treatment plans (Ferdinand, 2013). The telemonitoring technique allows the healthcare provider to receive instant and real time news and information relating to a patient and then relayed via a mobile phone as collected by the monitoring devices within the patient’s area of residence (Trudel, Cafazzo, Hamill, Igharas, Tallevi, Picton & Logan, 2007).
Discussion
The purpose of this paper is to expound on the role of telemonitoring technique as a method for increasing adherence, improving self-care and self-management and enhancing the vital patient-provider relationship for cases of hypertension within the African American population (Ferdinand, 2013). The research is therefore based on seeking answers to the PICOT question state as follows; “Are adult African American patients (P), who are monitored remotely (I) compared with those that are not monitored (C) at a decreased risk of hypertensive complications and noncompliance (O) over a six-month period after initiation of antihypertensive medications (T)?”
Trudel, Cafazzo, Hamill, Igharas, Tallevi, Picton & Logan (2007) in their study sought to determine the impact of a telemonitoring technique for diabetic and hypertension patients. In their study, the researchers had sought to analyze the issues such as workflow as well as concerns leveled by the healthcare providers when utilizing this technique as well as the apparent discomfort that the patients may have with the use of technologies. The telemonitoring equipment used in this case was user-centered and the patient played an active role on the monitoring and management of their condition with the help on their assigned care provider. The patients were placed on both a BP monitor and a glucometer all which relayed the results to the healthcare provider. While some features of the mobile phone used by the patient were difficult to use for a majority of the participants, the end results indicated improvements for all patients particularly on adherence as well as confirming that ambulatory monitoring is the current standard for BP monitoring. This study supports the need for utilizing telemonitoring by developing easy to use systems that are user friendly.
The study by Ferdinand (2013) indicates that there are many other factors whose influence on the cases of hypertension in African Americans cannot be underestimated. Among these is the income status whereby there are significant indications that persons within higher income groups are more likely to indicate greater adherence to medication and improved self-care and self-management as compared to those within the lower income groups. In this study, the author also reports of the gender-related differences especially in medication with particularly instance where the data from the study at JHS indicated that men were less likely to adhere to thiazide medication as compared to women. This particular difference was associated with the perception that thiazide has an association with erectile dysfunction. These are some of the factors that have remained unresolved within some groups and whose impact on adherence has been massive. Even in the event of adoption of telemonitoring these external factors that influence adherence need be managed concurrently.
The public health system has to appreciate the need for managing the cases of hypertension as early as they are detected. This is particularly due to the burden that hypertension places on the public both on costs of recurrent hospitalization, morbidities and mortalities. Vasan, Beiser, Seshadri, Larson, Kannel, D'Agostino & Levy (2002) in their study focused on establishing the residual lifetime risk that hypertension causes on the older adults within the US with a view of determining the temporal trends of the associated risk. Based on a sample population of 1298 participants, the researchers utilized a community-based prospective methodology. By understanding the temporal risks, the researchers identified that they could predict the burden that such cases could have in the future and therefore develop responsive measures. There was a higher risk for hypertension in men as compared to women and this once more indicated a gender-related influence for hypertension. Thus, in designing the strategy for public health, there is a need to understand the link between gender and the higher incidences and risks of hypertension.
Conclusion
There is no doubt that the burden of hypertension on the public health system is massive especially going into the future. New cases of hypertension are being diagnosed daily and those that are already diagnosed are being poorly managed leading to progression to severe such as Chronic Kidney Diseases and other cardiovascular illnesses (Flack, Nasser & Levy, 2011). A majority of the cases that progress to severity are associated with poor adherence to medication as well as other socioeconomic determinants such as income status, level of education as well as cultural and societal perceptions. Apparently, each of these is modifiable especially within a setting where the healthcare provider has developed a close working relationship with their patient. Telemonitoring is one of the platforms that eliminate the physical barriers between the patient and the healthcare provider that have previously limited the ability of the patient population to adhere to medication, treatment and therapies (Trudel, Cafazzo, Hamill, Igharas, Tallevi, Picton & Logan, 2007).
Foreground and Background Information
In the development of research questions, the researcher has to be in a position where they can dissect the range of issues that arise from the topic or aspect under investigation. While the PICOT question is the statement or question that directs the objectives and goals for a research, there are other pertinent questions that can be derived from the PICOT so as to fully address the entire clinical question in detail and derive viable answers (Aslam & Emmanuel, 2010). In this case, the clinical PICOT question can give rise to two forms of questions; the foreground questions which give rise to the foreground information or the basic information relating to the topic and for which cannot be ignored while exploring the PICOT (Aslam & Emmanuel, 2010).
In relation to the current question “Are adult African American patients (P), who are monitored remotely (I) compared with those that are not monitored (C) at a decreased risk of hypertensive complications and noncompliance (O) over a six-month period after initiation of antihypertensive medications (T)?” we can derive the following foreground question;
What is hypertension?
What are the comorbidities related to hypertension?
Are there significant disparities in cases of hypertension across racial and ethnic groups?
What is the role or mechanism of action of antihypertensive medication?
What is remote monitoring and what is its role in the management of patients with hypertension?
On the other hand we have the background questions which are more specific and detailed. These questions are patient-oriented and they primarily seek to provide interpretation of a disease or therapy, comparison of the benefits and risks of a therapy to the patient population as well as issues of sensitivity and the specificity of a particular therapy or treatment regimen (Aslam & Emmanuel, 2010). In this case, the possible foreground questions include;
Does the remote monitoring of hypertensive patients improve outcomes and adherence?
Does the application of monitoring improve self caring and self management techniques?
Would it be necessary to integrate patient education alongside the remote monitoring? if not, what is the role of the physician or care provider in remote monitoring?
References
Aslam, S., & Emmanuel, P. (2010). Formulating a researchable question: A critical step for facilitating good clinical research. Indian Journal of Sexually Transmitted Diseases and AIDS, 31(1), 47.
Ferdinand, K. C. (2013). Improving approaches to hypertension treatment in African Americans: lessons learned from the Jackson Heart Study. The Journal of Clinical Hypertension, 15(6), 362-364.
Flack, J. M., Nasser, S. A., & Levy, P. D. (2011). Therapy of Hypertension in African Americans.American Journal Cardiovascular Drugs, 11(2), 83-92. doi:10.2165/11586930-000000000-00000
Trudel, M., Cafazzo, J. A., Hamill, M., Igharas, W., Tallevi, K., Picton, P., & Logan, A. (2007). A mobile phone based remote patient monitoring system for chronic disease management. Studies in health technology and informatics, 129(1), 167.
Vasan, R. S., Beiser, A., Seshadri, S., Larson, M. G., Kannel, W. B., D'Agostino, R. B., & Levy, D. (2002). Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.Jama, 287(8), 1003-1010.
