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<< Previous   of   Next >> Kevin Nortz / The Herald  (click to enlarge) Lee Fowble of Edmonds was one of more than 700 patients who participated in a Group Health study of Web-based care.   ADVERTISEMENT   CONTACT THE HERALD Robert Frank, City Editor frank@heraldnet.com   Published: Monday, July 7, 2008 Group Health tries Web-based care to treat high blood pressure By Sharon Salyer, Herald Writer EDMONDS – Hypertension? Lee Fowble says he wasn't sure he knew what the word meant. And computers? "The work of the devil," he said, chuckling. "I can receive and send e-mails, period." This might not sound like a great match for a Group Health study involving home monitoring of high blood pressure, or hypertension, and regularly reporting the results -- by e-mail. Yet for all his humor about his lack of computer proficiency, Fowble, who is 71, was conscientious about his assigned tasks. "There were certain patients who really took this on," said Shannon Jewell, a Group Health pharmacist. "We were in constant communication. He is a character. His e-mails were always fun." Jewell monitored Fowble's progress, adjusted his medications and gave him tips on diet and other lifestyle changes he could make to lower his blood pressure. Both were participating in a test to see whether blood pressure checks outside the doctor's office, combined with regular e-mail contact with a pharmacist, could be an effective tool in bringing high blood pressure under control. The results from the four-year study found it to be nearly twice as effective in dropping blood pressure to near-normal ranges within a year, when compared with patients receiving traditional care of medications and visits to a doctor's office. Those with the highest blood pressure, systolic levels 160 or above, had even better results even though they are usually the hardest patients to treat, said Dr. Beverly Green, a Group Health researcher who helped lead the study. Fowble was one of more than 700 patients participating in the project. The $2.8 million study was funded by the National Heart, Lung and Blood Institute. Many of the patients were in their late 50s or older. It is thought to be the first major test of Web-based care to treat a chronic disease. Blood pressure problems are one of main reasons people go to the doctor, "up there with colds and back pain," Green said. High blood pressure affects about one third of all American adults. Hypertension can cause heart attacks and strokes. It is often called the silent killer, because it has no symptoms. The study's results underscore the importance of follow-up with patients in helping them monitor health conditions and encouraging them to change behaviors, said Dr. Matt Handley, Group Health's associate medical director for information technology. The techniques used in the study just scratch the surface of how to provide health care in a fundamentally different way, with fewer office visits, for common health problems, he said. "Most of the time, patients aren't actually interested in giving up two to four hours of their day" for an office visit, he said. Nearly half of all Group Health patients already are signed up to get some medical advice through its confidential e-mail system, he said. The cooperative receives 5,000 to 6,000 e-mail messages a day from patients sent outside normal business hours. "The fact is, the majority of our patients enjoy working with us virtually," he said. "It makes their care more efficient, affordable and as the study shows, can lead to better outcomes – a triple whammy." But do patients feel e-mail conversations with medical staff are less personal than in person office visits? "People used to say no one would want to bank online because they enjoyed talking to the teller," he said. "My goodness!" The study could pave the way for using e-mail and other technology to treat other common problems, such as diabetes, heart disease, and possibly chronic pain and depression, Handley said. Pharmacists were chosen to be the medical contact for patients participating in the study because they're used to helping patients with questions on medicine, and most blood pressure patients take at least two kinds of medication, Green said. Fowble said he had no idea he had a problem with high blood pressure. For years, he regularly donated blood, which always required a blood pressure check. The readings typically were in the normal range of 120/70. His problem with hypertension was only discovered when he was preparing for eye surgery, when his systolic reading hit 170. "The thing about hypertension is you can have it and not know it," Fowble said. "I didn't feel a bit different that day than any other." The study forced him to monitor his blood pressure much more closely that he otherwise would have. "Most of us start out doing this with the best of intentions," Fowble said. But there's something about good intentions, he said. "They go out like a flash cube." Fowble said he came to enjoy the e-mail contacts he had with Jewel. "I would ask her about diet and so forth," he said. "She would say lay off the salt, but pepper is fine. When she told Fowble the study was coming to an end "I almost felt like we were getting a divorce," he said. "We had gotten to be pretty good friends." The combination of diet tips and tweaking of medications helped him lower his blood pressure to a much healthier reading of 130/75. If people paid more ongoing attention to health issues, he said, "they wouldn't wait 'til it got to the critical stage before they did something about it." Reporter Sharon Salyer: 425-339-3486 or salyer@heraldnet.com

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