Hypertensive disorders of pregnancy (HDP) significantly contribute to maternal morbidity and mortality in the U.S., which exhibits one of the highest maternal mortality rates among high-income countries. Approximately 10% of pregnancies are affected by forms of HDP such as chronic hypertension, preeclampsia, and gestational hypertension, leading to severe health risks for mothers and neonates. Home blood pressure monitoring (HBPM) is proposed as a solution to enhance care quality, providing timely and relevant data critical for informed clinical decisions regarding hospital admissions and treatments. A recent study investigates the viewpoints of clinicians and highlights the challenges encountered in implementing an app specifically designed for hypertensive disorders of pregnancy (HDP).
The exploration of clinicians’ perceptions regarding the integration of an HDP-specific app, P-COACH, revealed potential benefits but also highlighted significant challenges. Key insights were gathered through qualitative interviews with diverse clinicians who provided multifaceted views on the utility of such applications in managing HDP. Participants pointed out that HBPM could improve access to care, especially for underserved populations affected by socio-economic barriers and rural healthcare challenges. They recognized the unique motivation of pregnant individuals to engage in health-improving behaviors during this period, suggesting P-COACH could facilitate sustained hypertension management through empowerment and education.
Barriers to Home Blood Pressure Monitoring
However, concerns regarding affordability of BP monitoring equipment limited the accessibility of HBPM. The financial burden, coupled with the need for literacy-appropriate resources, poses barriers to successful implementation. Clinicians highlighted the need for streamlined workflows and integration of HBPM data into electronic health records (EHRs) to reduce the administrative burden on healthcare providers and focus more on patient care. The unawareness of critical BP readings could put patients at risk, emphasizing the necessity for defined protocols and clear roles among care team members to interpret and act on BP data accurately.
Considerations for P-COACH Implementation
Implementing P-COACH successfully requires addressing barriers including liability issues associated with patient-generated data oversight, as well as ensuring providers receive adequate training and resources. Participants underscored the importance of developing an understanding of individual patient risks to tailor alerts meaningfully and responsively. Despite the promising features of P-COACH in enhancing communication, continuity of care, and mitigating complications postpartum, potential limitations include the need for broader studies encompassing varied healthcare settings and patient perspectives. Engaging diverse populations and ensuring affordable access to technology remain critical for equitably addressing HDP challenges and improving maternal health outcomes.
Key Points
- -Maternal Morbidity and Mortality-: Hypertensive disorders of pregnancy (HDP) are significant contributors to maternal morbidity and mortality in the U.S., with around 10% of pregnancies affected by conditions like chronic hypertension, preeclampsia, and gestational hypertension. These disorders are associated with severe health risks for mothers and neonates, highlighting the need for effective management and intervention strategies.
- -Home Blood Pressure Monitoring (HBPM) Benefits-: Incorporating HBPM into prenatal care can enhance the quality of healthcare delivery by providing timely, relevant blood pressure data, which are crucial for informed clinical decisions regarding hospital admissions and treatments. This method addresses access disparities, particularly for underserved demographics affected by socio-economic challenges and rural healthcare limitations.
- -Clinician Insights on P-COACH-: Qualitative interviews with clinicians reveal that while there are potential advantages in using the HDP-specific app P-COACH, there are also significant hurdles. Clinicians recognize the app's potential to motivate pregnant individuals to engage in health-improving behaviors and aid sustained management of hypertension.
- -Barriers to Effective HBPM Implementation-: Concerns regarding the affordability of blood pressure monitoring equipment, alongside the need for literacy-appropriate resources, hinder the successful implementation of HBPM. Clinical feedback indicates that streamlined workflows and incorporation of HBPM data in electronic health records (EHRs) are necessary to alleviate administrative burdens and concentrate on patient care.
- -P-COACH Implementation Considerations-: Effective implementation of P-COACH necessitates addressing various barriers, such as liability issues related to patient-generated data and ensuring healthcare providers are adequately trained. Tailoring alerts based on individual risk profiles is emphasized for responsive and meaningful patient engagement.
- -Need for Broader Studies and Engagement-: While P-COACH offers promising features for improving communication and continuity of care, limitations such as the need for more extensive studies across diverse healthcare settings and patient viewpoints persist. Ensuring affordable access to technology and engaging varied patient populations are critical to equitably confront HDP challenges and enhance maternal health outcomes.
Reference –
Shannon Canfield et al. (2025). Using RE-AIM To Inform The Adaptation Of A Clinical Decision Support Application For Hypertension Disorders Of Pregnancy: A Qualitative Study Of Provider Perspectives. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07632-x.
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