Improving Telemedicine for Black Patients with Heart Disease

Across all areas of study in health care and especially in recent years, African American patients and physicians have experienced racial inequity regarding telemedicine practices across the US.

However, a new pilot trial from the Perelman School of Medicine at the University of Pennsylvania suggested that subtle modifications in the methods of virtually engaging with Black patients and physicians could be used to better communicate with populations affected by these inequities.

Data from the trial showed that Black patients with cardiovascular disease covered under Medicaid and Medicare insurance are significantly more likely to share blood pressure measures with a clinician through text messages as opposed to a healthcare system online portal.

Jennifer Lewey, MD, MPH, Director of the Penn Women’s Cardiovascular Center, spoke of the motives behind this trial as well as the uptake and acceptability of a text-based model for at-home blood pressure monitoring when compared to online virtual patient portals among Black patients with Medicaid or Medicare.

“The motivation behind doing this was to really understand the best ways to improve blood pressure monitoring at home, especially knowing the higher rates of uncontrolled hypertension and cardiovascular morbidity and mortality experienced by Black individuals,” Lewy said. “I think what really stood out to us was the much higher rate with which patients reported their blood pressure by text messaging, the number of blood pressures that they reported, and also the satisfaction with the program (and) how much easier it was for people to report their blood pressures by texting versus using the portal.”

Lewy added that many of the patients had reported having to ask their child or other household members to help them in submitting their blood pressure levels when using the online portals, and how much easier it was for patients to instead send updates via text.

Often, clinicians will ask patients to submit their blood pressure log from home, as these readings can be more accurate than when a patient visits an office. However, self-monitoring can prove challenging for patients for a variety of reasons, and delays in submitting their blood pressure numbers can lead to inaccuracies and poor treatment.

With the text message method, patients received immediate feedback about their blood pressure numbers, which brought a more personalized feel to the process of monitoring their blood pressure.

Though the trial was conducted on 20 self-described Black patients, Lewy is hoping that the text-based model will be more widely distributed soon. In doing so, she added that teams to collect and interpret blood pressure data would have to be created to establish quick and consistent care.

In addition to complications within the workforce such as burnout and issues regarding the electronic medical record systems, Lewy added that the issue of access should also be considered when implementing these practices on a larger scale.

“I think whenever we're looking at any of these interventions, taking a lens towards equity is important too in terms of who has access to these devices,” Lewy said. “So it's not only who uses them at home but who can afford to use them? Who is actually prescribing them? And how do you use that information?”

To hear more from Dr. Lewy on the pilot trial and what physicians and patients can do to bridge the equity gap in cardiology care, listen to the latest episode of DocTalk above.