EXECUTIVE SUMMARY

A telemedicine program uses a case management model to help postpartum women manage hypertensive disorders.

  • The goal is to engage with the postpartum women through telemedicine that includes giving them a blood pressure cuff and calling them from a nursing call center.
  • Women text their blood pressure results; high numbers can trigger an alert that the program will address.
  • The program improved postpartum engagement with follow-up care, partly because it was more convenient for new mothers to test their own blood pressure and text the results rather than drive to a clinic and wait for an appointment.

A case management approach to monitoring women with hypertensive disorder during pregnancy positively affects women’s health post-pregnancy.

Recent public health data show that women increasingly are dying and becoming seriously ill after childbirth due to multifactorial issues, including obesity and age. For instance, hypertension complicates up to one in five pregnancies in the United States and is the cause of 14% of global maternal deaths.1

A new study shows the benefits of developing a case management program to monitor women with pregnancy-related hypertension. Researchers found evidence of high compliance, retention, and patient satisfaction with a postpartum remote hypertension monitoring protocol.1

Women with pregnancy-related hypertensive disorder typically are discharged home a couple of days after childbirth. They usually are told to visit their doctor within two weeks. If their blood pressure remains high, they might be prescribed medication, says Alisse Hauspurg, MD, assistant professor of obstetrics, gynecology, and reproductive sciences at the University of Pittsburgh School of Medicine and Magee-Womens Research Institute in Pittsburgh.

“Most women are not seen again until four to six weeks postpartum,” Hauspurg says. “For women that have pre-eclampsia or gestational hypertension, we talk about these conditions heightening their risk for cardiovascular disease.”

Studies show that traditional postpartum monitoring results in as many as 40% of women not seen in follow-up care after giving birth.1 Although hospital providers will ask the women to see their doctor after discharge, the women often fail to make these appointments. This could lead to a health crisis, Hauspurg says.

The solution was to find a way to encourage women to seek follow-up care and prevent medical emergencies due to their hypertensive condition. “We’re trying to engage these women more and to move some of the care outside of a clinic, using telemedicine in their homes,” Hauspurg says. “We discharge them home with a blood pressure cuff, and they’re called by a nursing-driven call center.”

Case managers can play a role in helping to train women at discharge to use blood pressure cuffs, she adds.

The program has resulted in more women following up on seeking postpartum medical checkups. More than 80% of the women came in for their follow-up visit, compared with 60% that usually return for this postpartum visit, Hauspurg says.

Here is how the program works:

• Enroll women in the program. After childbirth, women with hypertensive disorder are enrolled into the cardiovascular monitoring program. They need a text-message-enabled phone, and they need to learn how to use a blood pressure cuff, Hauspurg says.

“We ask them to check their blood pressure regularly and to send the blood pressure numbers to the program,” she explains. “It is connected to the electronic health record and it goes into the medical record, giving us the ability through the nursing call center to start medications.”

• Follow up on alerts. If a patient reports a critically high blood pressure result, an alert is triggered. The patient is asked to come into the clinic for an evaluation, Hauspurg says.

“This goes on for six weeks postpartum,” she adds. “They get to keep their blood pressure cuff, and our hope is they will be able to monitor it at home after the six weeks.”

By keeping the women engaged and helping them learn more about their health and blood pressure numbers, the goal is to empower them to know when they are at an increased risk of hypertension and cardiovascular disease, she says.

“Our hope is that, while the program only lasts six weeks, it will have an impact beyond that,” Hauspurg says.

• Survey women about obstacles. “We did surveys of women to assess their comfort levels in measuring blood pressure and with the program,” Hauspurg says. “Most women felt very comfortable with the program.”

For instance, they found that women in the childbirth age group were comfortable with text messages. There was no need for automated messages. They readily measured their blood pressure and texted the results, she says.

“When we looked at the proportion of women who continued the program through each postpartum week, by two weeks we had 95% involved. By three weeks, it had dropped down to 83%, so it did fall over time,” Hauspurg says. “We know from physiologic data that women are at their highest risk for critically high blood pressure during the first two weeks after giving birth.”

• Make the program sustainable. For the health system, the cost was sustainable and easily scalable, Hauspurg says.

“We give new blood pressure cuffs to each group, and the program is continuing,” she says. “There are more than 1,000 women enrolled in the program.”

The point of the program is for technology to meet women where they are, taking into consideration the population’s special considerations. “What we’ve practiced in the postpartum period has been mainly based on a clinic and asking women to come into it,” Hauspurg says.

Visiting a clinic can be difficult because the patients have a newborn at home and competing demands that make visiting a doctor for their own health more challenging. Using telemedicine and technology to make follow-up more convenient for women is a good way to improve monitoring and prevent health crises, she says.

“I think technology is definitely meeting women where they’re at in this population,” Hauspurg says.

REFERENCE

  1. Hauspurg A, Lemon LS, Quinn BA, et al. A postpartum remote hypertension monitoring protocol implemented at the hospital level. Obstet Gynecol 2019;134:685-691.