Five severely elevated blood pressures were sent to the physician responder, all from a single patient. This patient had been discharged home on hydrochlorothiazide 12.5 mg for persistently elevated blood pressures while in the hospital after being diagnosed with severe preeclampsia. All five “at risk” blood pressures were addressed within 24 hours of the text message. On her fifth day of remote surveillance, 5 mg of amlodipine was added to her daily regimen for blood pressures ranging from 150–170/90–110 mm Hg. Her blood pressure at her 6-week postpartum visit was 120/60 mm Hg and she had seen her primary care doctor in the interim for further hypertension management.
Cycle 5 - Snooze and Countdown
Although most of the patients enrolled in Cycle 4 stated that they were very busy in the immediate postpartum period and not always able to respond in a timely fashion, allowing patients to receive the reminder text at their own designated convenient time did not increase engagement. Patients reported that while they always carried their cell phones, they did not always carry their blood pressure cuff, limiting their ability to send in a reading at the time of the reminder. Additionally, patients reported feeling less motivated to continue texting blood pressures towards the end of the cycle. Cycle 5 tested our hypothesis that patient engagement would improve if reminder text messages were sent closer to the morning or evening deadline. Patients were provided with the opportunity to request “snooze” response if they did have their cuff accessible. Additionally, standard responses were accompanied by a countdown message. For example, “Your blood pressure looks good. Four more days of checking your blood pressure to go.”
All five enrolled in this cohort sent in at least one blood pressure, and all (100%) transmitted at least one blood pressure text on post-discharge day 1 or 2 and on day 5, 6, or 7. Only two “snooze” requests were made over the course of the arm by a single patient, who responded both times after the additional reminder.
Four severely elevated blood pressures were sent to the physician responder, all from a single patient. This patient was diagnosed with preeclampsia with severe features on delivery admission, and her blood pressures normalized prior to discharge. All four “at risk” blood pressures were addressed within 24 hours of the text message. Due to persistently elevated diastolic blood pressures ranging from 110–120 mm Hg, she was started on hydrochlorothiazide 12.5 mg on day 6 of the cycle and monitored for additional days following cycle completion with improved blood pressures.
Cycle 6 - Snooze and Support Person
The patients in Cycle 5 were overall satisfied with their experience and did not provide any suggestions for change. However, we sought to see if integrating support persons into the protocol would affect engagement. Cycle 6 tested our hypothesis that patients would be more engaged if they had a self-identified support person reminding them to text their blood pressures. Patients provided the name of a support person to contact if a morning blood pressure was not received. Additionally, patients received the same “snooze” option as in Cycle 5. A total of five patients were enrolled in this cohort; one patient enrolled in the trial but did not send in any blood pressures despite daily reminders to both her and her support buddy. Only 2 additional buddy notifications were required in patients who did not send in a morning blood pressure reading and both times a subsequent blood pressure was sent. Two “snooze” requests were made over the course of the cycle by a single patient, who responded both times after the reminder.