Patient self-monitoring of blood pressure and self-titration of medication in primary care: the TASMINH2 trial qualitative study of health professionals’ experiences

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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Self monitoring of blood pressure at home: Primary care professionals remain sceptical

BMJ ◽

10.1136/bmj.330.7483.148-b ◽

2005 ◽

Vol 330 (7483) ◽

pp. 148.3

Author(s):

Malcolm Aylett

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Self Monitoring ◽

Primary Care Professionals ◽

At Home

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

10.12788/jcom.0068 ◽

2021 ◽

Vol 28 (5) ◽

Author(s):

Mateo

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Self Management ◽

Hypertension Management ◽

Self Monitoring ◽

Digital Intervention

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Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study

Journal of Medical Internet Research ◽

10.2196/jmir.3985 ◽

2015 ◽

Vol 17 (3) ◽

pp. e67 ◽

Cited By ~ 18

Author(s):

Jesús Montero-Marín ◽

Javier Prado-Abril ◽

Cristina Botella ◽

Fermin Mayoral-Cleries ◽

Rosa Baños ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Health Professionals ◽

Web Based

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Effect of free distribution of medicines on the process of care for adult patients with type 1 and type 2 diabetes and hypertension: post hoc analysis of randomised controlled trial findings

BMJ Open ◽

10.1136/bmjopen-2020-042046 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042046

Author(s):

Onella Charles ◽

Hannah Woods ◽

Muhamad Ally ◽

Braden Manns ◽

Baiju R Shah ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Access To Medicines ◽

Free Access ◽

Process Of Care ◽

Self Monitoring ◽

Free Distribution ◽

Randomised Controlled

ObjectivesThe Carefully Selected and Easily Accessible at No charge Medicines randomised controlled trial showed that patients receiving free access to medicines had improved diabetes and hypertension outcomes compared with patients who had usual access to medicines. In this study, we aimed to test the impact of providing free access to medicine to people with diabetes and hypertension on process of care indicators.DesignIn this post hoc analysis of randomised controlled trial findings, we identified process of care indicators for the management of diabetes and hypertension using relevant guidelines. The following process of care indicators were identified for diabetes management: encounters with healthcare professionals, blood pressure measurements, self-monitoring of blood glucose, annual eye and foot examination, annual administration of the influenza vaccine, and laboratory testing for glycated haemoglobin (HbA1c), low-density lipoprotein-cholesterol, serum creatinine and urine albumin to creatinine ratio. We identified the following process of care indicators for hypertension: encounters with healthcare professionals, blood pressure measurements, self-measuring of blood pressure, and serum tests for electrolytes, HbA1c, lipids and creatinine. Chart extractions were performed for all patients and the indicators for diabetes and hypertension were recorded. We compared the indicators for patients in each arm of the trial.ResultsThe study included 268 primary care patients. Free distribution of medicines may improve self-monitoring behaviours (adjusted rate ratio (aRR) 1.30; 95% CI 0.66 to 2.57) and reduce missed primary care appointments for patients with diabetes (aRR 0.80; 95% CI 0.48 to 1.33) or hypertension (aRR 0.41; 95% CI 0.18 to 0.90). Free distribution may also reduce primary care and consultant appointments and laboratory testing in patients with hypertension.ConclusionsImproving medicine accessibility for patients with diabetes and hypertension not only improves surrogate health outcomes but also improves the patient experience and may also reduce healthcare costs by encouraging self-monitoring.Trial registration numberThe randomised controlled trial mentioned is clinicaltrials.gov identifier: NCT02744963.

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Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study

BJGP Open ◽

10.3399/bjgpopen20x101101 ◽

2020 ◽

Vol 4 (5) ◽

pp. bjgpopen20X101101

Author(s):

Jacob A Andrews ◽

Kate Weiner ◽

Catherine M Will ◽

Flis Henwood ◽

Jon M Dickson

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Home Monitoring ◽

Home Blood Pressure ◽

Patient Anxiety ◽

Focus Group Study ◽

Self Monitoring ◽

New Ways Of Working ◽

Adherence To Medication ◽

Primary Care Practitioners

BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed.ResultsThemes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors.ConclusionThe work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.

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