Remote Blood Pressure Monitoring Pharmacist-Led Telehealth Program in an Emergency Department Transition Care Clinic: A Pilot Study

Background: Hypertension is a leading cause of Emergency Department (ED) visits, particularly among underserved populations lacking access to primary care. Timely blood pressure (BP) management following ED discharge is critical for preventing adverse cardiovascular outcomes. We conducted a pilot study evaluating the feasibility, acceptability, and preliminary effectiveness of a remote BP monitoring (RBPM) and pharmacist-led telehealth program at an ED-transition care clinic (TCC). Methods: We conducted a pilot hybrid type 2 implementation-effectiveness randomized trial at the University of Alabama at Birmingham ED-TCC from July 2024 to April 2025. Adults ≥18 years with BP ≥130/80 and ≤160/100 mmHg, with smartphone access, no established primary care provider, and English fluency were enrolled and randomized 1:1 to intervention or usual care. The 12-week intervention included: (1) RBPM using automated BP cuffs transmitting readings to the study team, (2) twice-daily BP measurements (3 readings in AM and PM), and (3) weekly pharmacist telehealth visits for medication titration and barrier discussion, with physician review and confirmation of any medication changes. Outcomes were assessed at 3-month follow-up via in-person BP measurement and standardized questionnaires. Results: The 24 participants had a mean(standard deviation) age of 50 (13) years; 38% were female; 71% were Black; and 42% had a high school education or less. In the intervention group, baseline BP was 155 ± 15/102 ± 10 mmHg improving to 129 ± 13/ 88 ± 9 mmHg at follow-up. Of these 12 participants, 3 (25%) were lost to follow up, 6/9(67%) adhered to the complete protocol; 7/9 (78%) had controlled BP(<130/80 mmHg) at 12 weeks. Reported barriers included difficulty remembering to take BP measurements due to work schedules and medication cost. All 9 rated the intervention as highly acceptable, appropriate, and feasible. In the usual care group , baseline and follow-up BP were 154 ± 22/96 ± 17 mmHg and 12 8± 23/85 ± 15 mmHg, respectively; 4 participants (33%) were lost to follow-up, and 4/8 (50%) achieved BP control at 12 weeks. Conclusion: This pilot trial demonstrates that a RBPM pharmacist-led telehealth intervention in an ED-TCC setting is feasible, acceptable, and may improve BP control among high-risk adults lacking primary care access.