scholarly journals Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff—a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037874
Author(s):  
Lisa Hinton ◽  
James Hodgkinson ◽  
Katherine L Tucker ◽  
Linda Rozmovits ◽  
Lucy Chappell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Maternity Care ◽  
Healthcare Providers ◽  
Home Monitoring ◽  
Structured Interviews ◽  
Group Discussions ◽  
Self Monitoring ◽  
Team Members ◽  
Registration Number ◽  
In Pregnancy

ObjectiveOne in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.DesignExploratory study using a qualitative approach.SettingEight hospitals, English National Health Service.ParticipantsObstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147).MethodsSemi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.ResultsThe main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety.ConclusionsThe potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women.Trial registration numberNCT03334149.

scholarly journals Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework

2020 ◽  
Author(s):  
Kerry Evans ◽  
Helen Spiby ◽  
Jane C Morrell
Keyword(s):  
Pregnant Women ◽  
Maternity Care ◽  
Public Involvement ◽  
Complex Interventions ◽  
Psychological Theory ◽  
Intervention Component ◽  
Group Discussions ◽  
Mrc Framework ◽  
Care Systems ◽  
In Pregnancy

Abstract Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

scholarly journals Self-monitoring of blood pressure for preeclampsia patients: Knowledge and attitudes

Curationis ◽  
2021 ◽  
Vol 44 (1) ◽  
Author(s):  
Johanna Munyungula ◽  
Simangele Shakwane
Keyword(s):  
Blood Pressure ◽  
Low Socioeconomic Status ◽  
The Self ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Maternal Deaths ◽  
Self Monitoring ◽  
Knowledge And Attitudes ◽  
Positive Attitudes ◽  
Positive Outlook

Background: Preeclampsia is one of the causes of maternal deaths and is also responsible for complications such as premature births worldwide. In South Africa, hypertensive disorders cause 14% of all maternal deaths. Evidence indicates that it may be beneficial to empower women to monitor their blood pressure (BP) in the comfort of their homes.Objectives: The purpose of this study was to explore and describe preeclampsia patients’ knowledge and attitudes towards the self-monitoring of their BP.Method: An exploratory, descriptive and contextual qualitative research study was conducted. Fourteen preeclampsia patients were purposively sampled and participated in the study. In-depth semi-structured interviews were used to collect data. Data were analysed using the thematic analytic approach.Results: The knowledge and attitudes towards the self-monitoring of blood pressure (SMBP) were explored. Four themes emerged, namely understanding of hypertension disorders during pregnancy, openness on self-monitoring at home, its hindrances and benefits. The participants portrayed limited understanding and knowledge of preeclampsia, yet they had positive attitudes towards monitoring BP themselves and were open and willing to do self-monitoring at home.Conclusion: The use of SMBP may relieve overcrowding in public healthcare institutions. Encouraging patients to participate in self-monitoring could promote active participation and a positive outlook on their pregnancies. The unavailability and unaffordability of the equipment may pose a challenge to women with a low socioeconomic status.

scholarly journals High turnover in clinical dietetics: A qualitative analysis

2020 ◽  
Author(s):  
Sarah J Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Life Stage ◽  
Healthcare Providers ◽  
Objective Measure ◽  
Comparative Approach ◽  
Public Healthcare ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
Conflict Cost ◽  
Manager Support

Abstract Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. Methods: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. Results: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

Home monitoring of blood pressure in pregnancy at high risk of pre-eclampsia

2001 ◽  
Vol 99 (1) ◽  
pp. 109-111 ◽  
Author(s):  
Jason Waugh ◽  
Paul Bosio ◽  
Marwan Habiba ◽  
Trudy Boyce ◽  
Andrew Shennan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Home Monitoring ◽  
In Pregnancy

scholarly journals Home Monitoring in Glaucoma

2018 ◽  
Vol 12 (2) ◽  
pp. 102 ◽  
Author(s):  
Toby Boote ◽  
Andrew J Tatham ◽  
◽  
◽  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Heart Rate ◽  
Intraocular Pressure ◽  
New Technologies ◽  
Home Monitoring ◽  
Self Monitoring ◽  
Digital Devices ◽  
Wide Range ◽  
Efficacy Of Treatment

A wide range of relatively cheap, wearable digital devices are now available that enable self-monitoring of parameters such as heart rate, blood pressure, physical activity and sleep patterns. Although these devices are often marketed at healthy people, new technologies that permit home monitoring may also have the potential to improve the detection and management of chronic diseases including glaucoma. If patients were able to measure their intraocular pressure or perform perimetry at home, many more measurements could be obtained, with the potential to improve our ability to differentiate true change from test–retest variability. Home monitoring may also improve our ability to determine efficacy of treatment and enhance patient engagement.

scholarly journals Primary care doctors’ views on self-monitoring of blood pressure and self-titration among patients with uncontrolled hypertension in Spain. The ADAMPA trial focus group study.

BJGP Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. bjgpopen20X101062
Author(s):  
Irene Marco-Moreno ◽  
Patricia Martínez-Ibañez ◽  
Eugenia Avelino-Hidalgo ◽  
Laura Bellot-Pujalte ◽  
Ignacio Barreira-Franch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Focus Group ◽  
Home Monitoring ◽  
Self Management ◽  
Uncontrolled Hypertension ◽  
Focus Group Study ◽  
Self Monitoring ◽  
Primary Care Doctors ◽  
Role Of Nursing

BackgroundDespite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension.AimTo explore the views and attitudes of primary care doctors participating in the ADAMPA trial regarding BPSM with self-titration.Design & settingA focus group study took place with primary care doctors participating in the ADAMPA trial, which was carried out in one health district of the Valencia Health System in Spain.MethodNine primary care doctors participating in the ADAMPA trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics.ResultsParticipating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control.ConclusionPrimary care doctors participating in the ADAMPA trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.

scholarly journals Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework

2020 ◽  
Author(s):  
Kerry Evans ◽  
Helen Spiby ◽  
Jane C Morrell
Keyword(s):  
Pregnant Women ◽  
Maternity Care ◽  
Public Involvement ◽  
Complex Interventions ◽  
Psychological Theory ◽  
Intervention Component ◽  
Group Discussions ◽  
Mrc Framework ◽  
Care Systems ◽  
In Pregnancy

Abstract Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.Results: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.

scholarly journals High turnover in clinical dietetics: A qualitative analysis

2020 ◽  
Author(s):  
Sarah J Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Life Stage ◽  
Healthcare Providers ◽  
Objective Measure ◽  
Comparative Approach ◽  
Public Healthcare ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
Conflict Cost ◽  
Manager Support

Abstract Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. Methods: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. Results: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

scholarly journals Women’s Experience of Pregnancy and Birth during the Covid-19 Pandemic: A Qualitative Study

2020 ◽  
Author(s):  
Niamh Keating ◽  
Brendan Dempsey ◽  
Siobhan Corcoran ◽  
Joan Lalor ◽  
Mary Higgins
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Neonatal Intensive Care ◽  
Healthcare Providers ◽  
Normal Pregnancy ◽  
Theory Approach ◽  
Information Uncertainty ◽  
Care Services ◽  
Care Systems ◽  
In Pregnancy

Abstract BACKGROUND: The COVID-19 pandemic has changed how maternity care services are provided worldwide. In an effort to contain the virus many providers have reduced the number of face-to-face visits for women. In addition, partner attendance is now prohibited in many circumstances in order to protect staff, and other service users, from potential infection. METHODS: A qualitative study with 14 women was conducted using a grounded theory approach. Data were collected between April to June 2020 and in-depth interviews were conducted either in pregnancy or in the first 12 weeks after the birth. RESULTS: Six categories emerged: loss of normality, navigating "new" maternity care systems, partners as bystanders, balancing information, uncertainty and unexpected benefits of pregnancy during the pandemic. Women described the challenges they faced with accessing information of the risk of COVID-19 in pregnancy and how to navigate the new hospital and community restrictions. For the most part women accepted many of the restrictions as they understood as being in place to keep them safe. They perceived themselves as vulnerable group despite apparent available evidence to the contrary. The loss of the partner as an advocate, particularly at the anomaly scan and in the neonatal intensive care, was a source of anxiety. Social media was the main source of information for many in place of traditional sources such as healthcare providers. Some unexpected benefits of restrictions included working from home which allowed women to manage normal pregnancy symptoms such as fatigue at home. CONCLUSION: The pandemic caused anxiety for pregnant women. This is exacerbated by uncertainty about the effects of COVID-19 on pregnancy and unclear messaging about restrictions. Pregnancy has a significant temporal component and so maternity services need to respond to women’s needs for information and support rapidly and effectively, with more interactive and personalised communication to support them to cope with uncertainty. The birth partner is an important role as an advocate for women. Containment strategies for the pandemic should be developed with this in mind and attempt to view the family as a unit rather than the woman in isolation.

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