scholarly journals Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 randomised controlled trial

2019 ◽  
Vol 69 (686) ◽  
pp. e612-e620 ◽  
Author(s):  
Sabrina Grant ◽  
James Hodgkinson ◽  
Claire Schwartz ◽  
Peter Bradburn ◽  
Marloes Franssen ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Home Monitoring ◽  
Data Communication ◽  
Free Text ◽  
Self Monitoring ◽  
Structured Care ◽  
Randomised Controlled

BackgroundSelf-monitoring of blood pressure is common but how telemonitoring with a mobile healthcare (mHealth) solution in the management of hypertension can be implemented by patients and healthcare professionals (HCPs) is currently unclear.AimEvaluation of facilitators and barriers to self- and telemonitoring interventions for hypertension within the Telemonitoring and Self-monitoring in Hypertension (TASMINH4) trial.Design and settingAn embedded process evaluation of the TASMINH4 randomised controlled trial (RCT), in the West Midlands, in UK primary care, conducted between March 2015 and September 2016.MethodA total of 40 participants comprising 23 patients were randomised to one of two arms: mHealth (self-monitoring by free text/short message service [SMS]) and self-monitoring without mHealth (self-monitoring using paper diaries). There were also15 healthcare professionals (HCPs) and two patient caregivers.ResultsFour key implementation priority areas concerned: acceptability of self- and telemonitoring to patients and HCPs; managing data; communication; and integrating self-monitoring into hypertension management (structured care). Structured home monitoring engaged and empowered patients to self-monitor regardless of the use of mHealth, whereas telemonitoring potentially facilitated more rapid communication between HCPs and patients. Paper-based recording integrated better into current workflows but required additional staff input.ConclusionAlthough telemonitoring by mHealth facilitates easier communication and convenience, the realities of current UK general practice meant that a paper-based approach to self-monitoring could be integrated into existing workflows with greater ease. Self-monitoring should be offered to all patients with hypertension. Telemonitoring appears to give additional benefits to practices over and above self-monitoring but both need to be offered to ensure generalisability.

scholarly journals 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 ◽  
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.

scholarly journals Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial

BMJ ◽  
2012 ◽  
Vol 345 (nov20 1) ◽  
pp. e7156-e7156 ◽  
Author(s):  
S. Stewart ◽  
M. J. Carrington ◽  
C. H. Swemmer ◽  
C. Anderson ◽  
N. P. Kurstjens ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Blood Pressure Targets ◽  
Structured Care ◽  
Randomised Controlled

scholarly journals Improving Primary Care After Stroke (IPCAS) randomised controlled trial: protocol for a multidimensional process evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036879
Author(s):  
Maria Raisa Jessica (Ryc) Aquino ◽  
Ricky Mullis ◽  
Elizabeth Kreit ◽  
Vicki Johnson ◽  
Julie Grant ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Process Evaluation ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Semistructured Interviews ◽  
Self Reports ◽  
Randomised Controlled ◽  
Audio Video ◽  
Purposive Sample

IntroductionPrimary care interventions are often multicomponent, with several targets (eg, patients and healthcare professionals). Improving Primary Care After Stroke (IPCAS) is a novel primary care-based model of long-term stroke care involving a review of stroke-related needs, a self-management programme, a direct point of contact in general practice, enhanced communication between care services, and a directory of national and local community services, currently being evaluated in a cluster randomised controlled trial (RCT). Informed by Medical Research Council guidance for complex interventions and the Behaviour Change Consortium fidelity framework, this protocol outlines the process evaluation of IPCAS within this RCT. The process evaluation aimed to explore how the intervention was delivered in context and how participants engaged with the intervention.Methods and analysisMixed methods will be used: (1) design: intervention content will be compared with ‘usual care’; (2) training: intervention training sessions will be audio/video-recorded where feasible; (3) delivery: healthcare professional self-reports, audio recordings of intervention delivery and observations of My Life After Stroke course (10% of reviews and sessions) will be coded separately; semistructured interviews will be conducted with a purposive sample of healthcare professionals; (4) receipt and (5) enactment: where available, structured stroke review records will be analysed quantitatively; semistructured interviews will be conducted with a purposive sample of study participants. Self-reports, observations and audio/video recordings will be coded and scored using specifically developed checklists. Semistructured interviews will be analysed thematically. Data will be analysed iteratively, independent of primary endpoint analysis.Ethics and disseminationFavourable ethical opinion was gained from Yorkshire & The Humber-Bradford Leeds NHS Research Ethics Committee (19 December 2017, 17/YH/0441). Study results will be published in a peer-reviewed journal and presented at relevant conferences.Trial registration numberNCT03353519; Pre-results.

Sign in / Sign up

Export Citation Format

Share Document