Leah Spiro, DNP, FNP-C

Abstract:

Objectives: To establish adherence to- and satisfaction with RPM and follow-up program in the management and care of patients with HDP after hospitalization for delivery. Background: Pregnancies complicated by HDP account for 2.5-4.6% of postpartum readmissions within six weeks of delivery, compared to 1% of deliveries in normotensive patients; 60% of readmissions occur in the first seven days postpartum. Standardization of HDP management can improve outcomes through optimized postpartum blood pressures. RPM has established safety, patient outcomes, financial benefit, and increased adherence, though few institutions currently utilize standardized protocols for HDP. Methods: Participants (n=13) received access to an application and a Bluetooth enabled blood pressure cuff that automatically uploaded to a provider monitored portal. Participants had a telehealth visit with a provider at 48 hours post discharge, with additional visits as needed. Adherence and satisfaction were measured through adherence with program requirements through ten days postpartum and participant surveys. Secondary outcomes included readmission through six weeks postpartum, incidence of out-of-range blood pressures, and recommendations for antihypertensive medication titrations to primary obstetricians. Results: Consent rate of 72% (13 of 18 approached), overall retention/adherence of 100%, as measured by adherence to study specifications, and stated satisfaction of 93.6% in post-participation surveys. No Readmissions amongst participants were documented. Conclusions and Implications: Validated utilization of RPM will indicate a feasible strategy in the management of HDP and reduction of cardiovascular sequelae. Blood pressure optimization and standardized care of HDP may decrease cardiovascular disease in women with subclinical risk factors. 

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