While some cases of postpartum preeclampsia occur in the absence of peripartum disease, most readmitted patients are diagnosed with preeclampsia prior to delivery and readmission is due to worsening or persistence of disease and therefore, potentially preventable. These patients are the primary target of our intervention, as remote hypertension surveillance provides an opportunity to start or adjust medications and minimize both patient inconvenience and hospital cost of a readmission.
However, our feasibility study has some limitations. Despite overall patient satisfaction, acceptability, and compliance with text message monitoring of hypertension, the small sample size and qualitative nature of our cycles merits further pursuit and follow-up studies prior to implementation. Overall, we had only a small number of elevated blood pressures requiring intervention; however, this underscores the need to identify patients most at risk for persistent or delayed hypertension and the importance of developing a method of follow-up that engages all patients. Additionally, as patients were asked to both text in blood pressure values and also present for office visits, and therefore acted as their own control, it is not surprising that more patients were compliant with the simple texting method than standard of care; however, even when comparing texting compliance to historical attendance in our clinic of only 30%, our results remain promising.
While our results are encouraging, we believe it is important to test text messaging surveillance and patient compliance in a larger trial prior to implementing within the broader community. This study provides critical data to support the development of a HIPAA-compliant, automated monitoring system that can provide timely responses to patient texts using a provider derived response to blood pressure values. Future work includes the development of an automated hypertension tool as well as a randomized controlled trial to more rigorously compare office blood pressure visits to remote text message surveillance. If effective, use of text messaging technology may allow for an improved patient partnership and more robust follow-up data, especially in patients with less than optimal compliance, as well as the ability to improve maternal care and decrease morbidity and mortality.
Corresponding author: Adi Hirshberg, MD, Dept. of Maternal- Fetal Medicine, 2 Silverstein, 3400 Spruce St., Philadelphia, PA 19104, adi.hirshberg@uphs.upenn.edu.
Funding/support: Supported by a Penn Medicine Innovation Accelerator grant.
Financial disclosures. None reported.