Patients’ experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study

Abstract

BackgroundSelf-management of hypertension, comprising self-monitoring of blood pressure with selftitration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it. AimTo explore patients' views of self-monitoring blood pressure and self-titration of antihypertensive medication. Design and settingQualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient selfmanagement of hypertension from 24 general practices in the West Midlands. MethodTaped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method. ResultsPatients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a selfmanagement plan. ConclusionParticipants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

“…A feasibility study done in lowrisk pregnant women showed a preference for blood pressure selfmonitoring with a reduced schedule of antenatal visits, and no change in anxiety levels [22]. Literature on blood pressure self-monitoring outside pregnancy indicates patients are confident at self-monitoring and report high levels of satisfaction and feelings of involvement, control, and support for their health [23,24]. In the current study similar findings for self-testing of urine are reported; women whose readings were used by HCPs felt valued and involved in their own care and reported positive experiences.…”

Thinking with Care Infrastructures: People, Devices and the Home in Home Blood Pressure Monitoring

“…Existing studies of home blood pressure monitoring have been largely undertaken within clinical populations, considering how people understand blood pressure, their motivations for undertaking monitoring and their communications with clinicians (e.g. Jones et al 2012, Vasileiou et al 2013, Tyson and McElduff, 2003. Rather than focusing on how people understand and interpret blood pressure numbers or how they respond to these numbers, we are interested here in the material and mundane aspects of independently undertaken blood pressure monitoring.…”

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

“…Poor guidelines, lack of self-monitoring protocols, and suboptimal interpretation by health professionals of home BP readings are just a few reasons suggested by recent literature to explain why patients are currently met with a relative lack of enthusiasm when presenting HCPs and/or GPs with home monitoring data. 8,15 A more effective approach to successful integration must be adopted through theoretically based patient education guiding clinicians and patients through collaborative and shared discussions of patients' priorities, treatment planning, specific goals, and follow-ups. Such active consultations within a 'shared decision-making approach' are increasingly being observed in hypertension consultations.…”

“…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.…”