At-home blood pressure cuffs—and reminders to use them—key to blood pressure control
In a Penn Medicine study designed to test ‘opt-in’ versus ‘opt-out’ nudging, what really matters is convenience and keeping patients’ condition top of mind.
2 min. read
For some patients struggling to control high blood pressure, something as simple as having blood pressure monitors at home and texted reminders to use them could be the key to stabilizing or even lowering their blood pressures, according to a new study by researchers at the Perelman School of Medicine.
When patients were mailed blood pressure cuffs, given the option to text back their readings to their clinical team, and also receive texted reminders to do so, 35% were able to get their blood pressure in check. Only 21% of those in the study who didn’t receive at-home cuffs but got regular care—readings taken in their primary care provider’s office—got the same result, according to the study published in JAMA Network Open.
“We were able to find a way to make this user-friendly and gently keep the importance of monitoring on patients’ minds so they could make the lifestyle, medication, or other adjustments they needed,” says lead author Shivan Mehta, associate chief innovation officer at Penn Medicine.
The research team set up their study to test a “nudge,” the behavioral science-informed concept of framing options and offering people choices to influence behavior.
The nudge the researchers tested was “opt out” or “opt in” framing of the choice to get blood pressure cuffs. One arm of the study involved mailing blood pressure cuffs to patients with hypertension before calling to ask them if they would text their reading numbers to their primary care practice. In this case, the patients could “opt out” of the program and not take the readings or text the results. The other nudge arm asked patients to sign up for receiving the cuff and text reminders before mailing the cuff to them (an “opt in” framing).
Analysis showed no statistically significant difference in the number of patients who took their blood pressure measurements between the opt-in or opt-out arms of the study. There was also virtually no difference in the number of blood pressure readings that patients submitted over the period among patients who participated in texting.
While the researchers can’t say with total confidence why there was so little difference in the findings between the opt-in and opt-out groups, Mehta has thoughts based on prior research.
“The main reason is that recruitment for both arms still required a phone call and consent to participate,” Mehta explains. “We’ve seen that, in general, opt-out approaches often work best when we remove effort to participate by both the patient and clinical staff. So, moving forward, patients could be automatically enrolled through texting without requiring a phone call.”
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