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

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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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 ◽

10.3399/bjgpopen20x101062 ◽

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.

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Abstract 118: Home Blood Pressure Monitoring Program improves Management of Hypertension

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a118 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Stephen Agboola ◽

Khinlei Myint-U ◽

Joseph Kvedar ◽

Kamal Jethwani

Keyword(s):

Blood Pressure ◽

Blood Pressure Monitoring ◽

Monitoring Program ◽

Home Monitoring ◽

Home Blood Pressure ◽

P Value ◽

Self Monitoring ◽

Most Significant Change ◽

Blood Pressures ◽

Stage 1

Objectives: Regular self-monitoring of blood pressure is an important aspect of the management of hypertension; it enables the hypertensive patient makes better lifestyle choices informed by the measurements obtained from their blood pressure devices. The BP monitoring program by the Center for Connected Health is aimed at empowering patients to better self-manage their health and facilitating improved communication between patients and providers. This study aimed to evaluate the effectiveness of the blood pressure connect program on lowering blood pressures of participants in the program. Methods: The Blood Pressure Connect is a home monitoring program enabling patients to easily collect their blood pressure readings, monitor trends and also share their readings with their providers. Patients measure their blood pressures and upload to a secure web-based platform via modem connection with a home telephone line. Of the 277 hypertensive patients from several Partners affiliated centers enrolled in the program between 7/10/2009 and 11/18/2011, 219 patients aged 22-90 years (59±13 years) were included in the analysis; and 58 (21%) patients were excluded from analysis because they either have only one blood pressure reading or did not upload their blood measurements at all. Paired t-test was used to assess mean change in systolic blood pressure (SBP). Results: Average interval between baseline and final blood pressure measurements was 154 days. According to the JNC-7 classification of blood pressures, 11% had normal SBP, 48% were pre-hypertensive, 30% had stage 1 hypertension and 11% had stage 2 hypertension. Overall, SBP decreased by 6mmHg (95% CI= 4 -8mmHg, p-value <0.0001). SBP decreased by 1mmHg (95% CI=-2 -3mmHg p-value = 0.51), 12mmHg (95% CI= 8 -15mmHg, p-value < 0.0001) and 25mmHg (95% CI=18 - 32mmHg p-value <0.0001) in pre-hypertensive, stage 1 and stage 2 hypertension respectively but increased by -7mmHg (95% CI= -13 - 1mmHg) in those with normal blood pressure. Conclusion: The results show that the program is extremely successful in helping lower the blood pressures of patients with hypertension. These patients belong to a variety of practices, are on different medications and for disparate lengths of time. Despite these differences, all active patients had very similar changes in blood pressure, varying only by their starting blood pressure. Those with established hypertension (stage 1 or 2) saw the most significant change, indicating where the maximum rewards of this program lie. These results reflect the applicability of remote monitoring tools in managing chronic conditions effectively and efficaciously.

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HBPM to refine the diagnosis of hypertension in a Family Health Care Unit in RJ, Brazil - LapARC

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1118 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T S Mello ◽

B G Botelho ◽

J V G Hollanda ◽

L A Antequera ◽

M A O Mourão ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Blood Pressure Monitoring ◽

Adult Population ◽

Home Monitoring ◽

Home Blood Pressure ◽

Neck Circumference ◽

White Coat ◽

Cross Sectional ◽

Diagnosis Of Hypertension

Abstract Background The new hypertension (HT) guidelines recommend the use of out-of-office blood pressure (BP) measures for its diagnosis however, in the scope of public health in Brazil, it is still based on office BP (OBP) for logistical and financial reasons. Furthermore, in our country, it is not yet clear whether the use of out-of-office BP would really be more reliable for the diagnosis. Objective To evaluate the importance of using Home Blood Pressure Monitoring (HBPM) in diagnosing HT in a young adult population in primary care in Brazil. Methods A cross-sectional population study enrolled adults between 20 and 50 years in a primary healthcare unit in Rio de Janeiro. Office BP was the mean value of 2 measures, while the HBPM followed a 7-day protocol. It was considered normal a Home BP < 135x85 mmHg and OBP <140x90 mmHg. Patients were classified into 4 phenotypes: normotension (controlled OBP and HBPM); white coat HT (uncontrolled OBP and controlled HBPM); masked HT (controlled OBP and uncontrolled HBPM) and sustained HT (uncontrolled OBP and HBPM). Results A total of 462 individuals were enrolled [38% males; mean age 36±9 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. OBP, the prevalence of HT was 13%, HBPM it was 19%, with low concordance between them (kappa=0.472). After HBPM, 17% changed the diagnosis, being 6% of them white-coat HT and 11% masked HT. The variables that were independently associated with HT diagnosed by OBP were male gender (OR 1.83,CI95%:1.01-3.33,p=0.04) and increased neck circumference (OR 3.77,CI95%:1.59-8.93,p=0.003), whilst by HBPM they were obesity (OR 2.18,CI95%:1.27-3.76,p=0.005) and increased neck circumference (OR 2.37,CI95%:1.05-5.33,p=0.04). Conclusions If the diagnosis was based only in the office BP values, 17% of the subjects would've had an erroneous diagnosis of hypertension, suggesting the importance of implementing out-of-office BP measurements in primary care. Key messages Home monitoring blood pressure corrected the diagnosis of hypertension of 17% of patients, allocating them correctly into white-coat HT and masked HT. Increased neck circumference was independently associated with the diagnosis of hypertension by both methods.

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Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study

Ciência & Saúde Coletiva ◽

10.1590/1413-81232021268.17012020 ◽

2021 ◽

Vol 26 (8) ◽

pp. 2997-3004

Author(s):

Jéssica Nunes Moreno ◽

Welma Wildes Amorim ◽

Sóstenes Mistro ◽

Danielle Souto de Medeiros ◽

Matheus Lopes Cortes ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Blood Pressure Monitoring ◽

Home Monitoring ◽

Cross Sectional Study ◽

Home Blood Pressure ◽

Pressure Monitoring ◽

Cross Sectional ◽

Altered Blood ◽

At Home

Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

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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 ◽

10.1136/bmjopen-2020-037874 ◽

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.

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