Evaluation of a Digital Intervention for Hypertension Management in Primary Care Combining Self-monitoring of Blood Pressure With Guided Self-management

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.

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Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

BMJ ◽

10.1136/bmj.m4858 ◽

2021 ◽

pp. m4858

Author(s):

Richard J McManus ◽

Paul Little ◽

Beth Stuart ◽

Katherine Morton ◽

James Raftery ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Systolic Blood Pressure ◽

Usual Care ◽

Controlled Trial ◽

Self Monitoring ◽

Digital Intervention ◽

Online Management ◽

One Year ◽

Randomised Controlled

Abstract Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting 76 general practices in the United Kingdom. Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration ISRCTN13790648 .

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Abstract TP206: The Influence of Contextual Factors on Gaps in Hypertension Management for Veterans with TIA/Minor Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp206 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jason J Sico ◽

Edward J Miech ◽

Teresa M Damush ◽

Ava B Keating ◽

Gregory W Arling ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Contextual Factors ◽

Primary Care Providers ◽

Minor Stroke ◽

Medical Attention ◽

Hypertension Management ◽

Cerebrovascular Event ◽

Care Providers ◽

Provider Perspectives

Introduction: Many patients with TIA/minor stroke do not achieve goal blood pressure their cerebrovascular event, thereby remaining at high risk for future events. Understanding the influence of contextual factors associated with post-event hypertension management may inform future intervention studies. Methods: As part of a national, observational study of TIA/minor stroke care across the Veterans Health Administration (VHA), in-person site visits were conducted at participating VHA medical centers in 2014-15. Semi-structured interviews were used to elicit provider perspectives about local practices related to the care of TIA/minor stroke patients. Study team members systematically applied codes transcribed files using qualitative, categorical, and quantitative descriptive codebooks. Investigators used Thematic Content Analysis and mixed-methods matrix displays to analyze coded data, generate, and then validate findings. Results: Seventy interviews were obtained from staff at 14 sites. Several contextual factors appeared to influence post-event hypertension care delivery for patients after a TIA/minor stroke. Neurologists reported that they perceived no direct responsibility for managing post-event blood pressure and were uncertain whether recommendations regarding blood pressure management were being implemented in primary care. Primary care providers expressed hesitancy about titrating antihypertensive medications post-event, citing concerns about permissive hypertension. Providers also reported that poor blood pressure control was not as salient to patients as symptoms, leading some patients to not adhere to their antihypertensives or not feel a sense of urgency in seeking prompt medical attention. VHA facilities did not have protocols to guide providers in the treatment of post-TIA/minor stroke hypertension, with centers expressing little compulsion to develop them. Conclusions: Multiple contextual factors at the provider- and system-levels were identified as barriers to achieving post-cerebrovascular event hypertension control; these data have informed the design of a recently funded vascular risk factor intervention.

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Personalized Hypertension Management Based on Serial Assessment and Telemedicine: a Cluster Randomize Controlled Trial Protocol in Anhui, China

10.21203/rs.3.rs-47983/v1 ◽

2020 ◽

Author(s):

Siyi Xiao ◽

Xingrong Shen ◽

Rong Liu ◽

Guixian Tong ◽

Tongzhu Liu ◽

...

Keyword(s):

Blood Pressure ◽

Low Cost ◽

Controlled Trial ◽

Population Based ◽

Future Research ◽

Hypertension Management ◽

Intervention Package ◽

Self Monitoring ◽

Intervention Measures ◽

Cluster Randomized

Abstract Background: Despite tremendous investment worldwide, hypertension treatment and control rates remain low, suggesting that contemporary population-based hypertension management may have reached its efficacy ceiling. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.Methods/design: PHMA strives to reduce hypertension harms by eight proven “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.Discussion: PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts so comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.Trial registration: Registered July 17, 2020. ISRCTN10999269.

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EVALUATION OF DIABETES SELF-MANAGEMENT EDUCATION IN PATIENTS WITH CONCOMITANT CHRONIC KIDNEY DISEASE

Wiadomości Lekarskie ◽

10.36740/wlek202010112 ◽

2020 ◽

Vol 73 (10) ◽

pp. 2170-2174

Author(s):

Oleksii M. Korzh

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Management Training ◽

Cross Sectional Study ◽

Self Management ◽

Average Score ◽

Cross Sectional ◽

Self Monitoring ◽

Diabetes Educators

The aim: Was to evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. Materials and methods: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach’s reliability coefficient for each domain / subscale was ≥ 0.7. The data were analyzed using an independent selective t-test and one-way ANOVA. Results: More than half of the doctors provided “inadequate quality” of diabetes self-management in all areas. Doctors had the highest average score in the domain of “drug intake” (4.46 ± 0.61). Average scores in the “problem-solving domain” (3.52 ± 0.63) and “ being active domain” (3.46 ± 0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. Conclusions: The quality of doctors’ communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behavior associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

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Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4)

Hypertension ◽

10.1161/hypertensionaha.118.12415 ◽

2019 ◽

Vol 73 (6) ◽

pp. 1231-1239 ◽

Cited By ~ 17

Author(s):

Mark Monahan ◽

Sue Jowett ◽

Alecia Nickless ◽

Marloes Franssen ◽

Sabrina Grant ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Cost Effectiveness ◽

Self Monitoring

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Patients' perceptions of self-management of high blood pressure in three low- and middle-income countries: findings from the BPMONITOR study

Global Health Epidemiology and Genomics ◽

10.1017/gheg.2020.5 ◽

2020 ◽

Vol 5 ◽

Author(s):

Tala Al-Rousan ◽

M. Amalia Pesantes ◽

Sufia Dadabhai ◽

Namratha R. Kandula ◽

Mark D. Huffman ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Cost Effective ◽

Self Management ◽

Middle Income ◽

Self Monitoring ◽

Caregiver Support ◽

Middle Income Countries ◽

Perceptions And Attitudes ◽

Low And Middle Income

Abstract Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient–physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.

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