Evaluating a large-scale roll out of blood pressure telemonitoring using routinely acquired data

Abstract

Background1.2 million appointments in Scottish primary care annually are used solely for checking blood pressure (BP). While evidence from randomised controlled trials (RCTs) shows that telemonitoring of BP produces significant reductions, it has not been mainstreamed because of difficulties in integrating telemonitoring with routine medical care. With NHS Lothian a system was developed which extracted data from a telemonitoring provider website, and delivered it as a routine DOCMAN report to GP practices without need for logons.AimTo determine the feasibility of implementing telemonitoring of high blood pressure (HBP) at scale in primary care and the potential of using routinely acquired data for exploring clinical and resource-use impacts.MethodPractice recorded BP, prescribing, and appointments data were transferred for all people with HBP to a safe-haven. We compared before and after BPs at 1 year from participants and non-participants. Patient and clinician interviews.ResultsOver 2400 people were recruited to telemonitoring overall. Over a year, BP control improved in both telemonitoring participants and non-participants. Mean systolic BP (SBP) fell by 6.6 mmHg in participants and 3.5 mmHg in non-participants. In uncontrolled participants (SBP >135 mmHg home-monitored) average fall was 15 mmHg. Proportion with very poor control BP (SBP >150 mmHg) fell from 13.6% to 3.4%. Appointment data were challenging to interpret, but there was little change from the previous year in face-to-face appointment time and total appointments. Patients and clinicians were positive about the implementationConclusionThe study demonstrated an improvement in BP control similar to effects in RCTs in routine general practice with little impact on workload using routinely acquired data providing strong support for mainstreaming low-cost telemonitoring for HBP.