Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study

Abstract

ObjectivesTo explore the experiences of patients and professionals taking part in a randomised controlled trial (RCT) of remote blood pressure (BP) telemonitoring supported by primary care. To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice.DesignQualitative study adopting a qualitative descriptive approach.Participants25 patients, 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring. A maximum variation sample of patients from within the trial based on age, sex and deprivation status of the practice was sought.Setting6 primary care practices in Scotland.MethodData were collected via taped semistructured interviews. Initial thematic analysis was inductive. Multiple strategies were employed to ensure that the analysis was credible and trustworthy.ResultsPrior to the trial, both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery. BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action. Patients using telemonitoring became more engaged in the clinical management of their condition. Professionals reported that telemonitoring challenged existing roles and work practices and increased workload. Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback.ConclusionsBP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control. It increases patients’ engagement in the management of their condition, but supporting telemetry and greater patient engagement can increase professional workloads and demand changes in service organisation. Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practices. The embedded qualitative study was included in the protocol for the HITS trial registered with ISRCTN no. 72614272.

Patients’ and clinicians’ views on the optimum schedules for self-monitoring of blood pressure: a qualitative focus group and interview study

“…15,24 However, there are few studies specifically looking at preferences for and the acceptability of using a home blood pressure monitoring schedule. The key original finding from the current study is in identifying that using a schedule was largely acceptable for most primary care patients with particular schedules favoured over others.…”

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

“…[25][26][27][28] Telehealth interventions can continuously monitor patients with CVD and may include anything from structured telephone support to remote monitoring of implantable devices, which can favorably affect CVD burden (such as significantly reducing blood pressure), progression of disease, and healthcare expenditures. [27][28][29][30] However, uptake by physicians is limited, especially in primary care and family practice. In a recent report, only 15% of family practitioners used telehealth to provide health care.…”

Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study

“…15,16 These studies suggest patients felt confident about selfmonitoring, trusting multiple home readings more than a single office-based reading, and that self-monitoring as part of the telemonitoring intervention helped patients feel more engaged in the clinical management of their condition. 16 However, the self-titration of medication aspect of one of the interventions was met with less enthusiasm despite the effect it had on BP. 20 Notwithstanding this evidence, uptake rates in the UK are lower than those seen internationally.…”

“…9,10 This is further supported by an increasing body of qualitative evidence showing patients want to understand more about their hypertension [11][12][13][14] and establishes links between self-monitoring and telemonitoring with medication adherence. [15][16][17][18][19] Two UK-based randomised controlled trials with embedded qualitative studies support the utility of self-monitoring, though authors do note that participant selection may also have inclusion bias. 15,16 These studies suggest patients felt confident about selfmonitoring, trusting multiple home readings more than a single office-based reading, and that self-monitoring as part of the telemonitoring intervention helped patients feel more engaged in the clinical management of their condition.…”

“…[15][16][17][18][19] Two UK-based randomised controlled trials with embedded qualitative studies support the utility of self-monitoring, though authors do note that participant selection may also have inclusion bias. 15,16 These studies suggest patients felt confident about selfmonitoring, trusting multiple home readings more than a single office-based reading, and that self-monitoring as part of the telemonitoring intervention helped patients feel more engaged in the clinical management of their condition. 16 However, the self-titration of medication aspect of one of the interventions was met with less enthusiasm despite the effect it had on BP.…”