Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system

Abstract

ObjectiveThis paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system.DesignA qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301.SettingFour primary health care centers in Sweden.SubjectsPatients with hypertension (n = 20) and their health care professional (n = 7).ResultsThe consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities.ConclusionPatients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension managementKey points The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations.Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life.These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

Experiences, expectations and challenges of an interactive mobile phone-based system to support self-management of hypertension: patients’ and professionals’ perspectives

“…The developed system has shown support for patients to become autonomous and take on extended responsibility for their health. 41 …”

Increased importance of digital medicine and eHealth during the Covid-19 pandemic

“…The subject of digital medicine, telemedicine, eHealth or the use of internet resources was mentioned in the title of 7 out of 104 original articles in the two latest volumes of the Scandinavian Journal of Primary Health Care [5][6][7][8][9][10][11].…”

“…The other six studies involved both patient and physician aspects with four studies emphasising e-learning [5,7,9,10] and two studies using digital data collection methods [8,11].…”

PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care

“…Patients with high blood pressure have been involved in all phases of the design, development and evaluation of the interactive web-based self-management support system that will be used in the intervention group ( Figure 2). The development, validation and results from the piloted version of the system have previously been described in detail [4,[10][11][12][13][14][15][16]. The system includes four components: (1) a module for selfreporting well-being, symptoms, lifestyle, medication intake and side effects of medication; (2) daily home BP and pulse measurements with a validated BP monitor; (3) tailored weekly motivational messages to encourage lifestyle changes and (4) web-based dashboard to enable patients, as well as physicians and nurses, to examine graphs for visualisation of the patient's BP in relation to the self-reports.…”