Abstract
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.
Highlights
The self-m onitoring of blood pressure at home was introduced in the 1930s1, and is associated with improved clinical outcomes in hypertension, when accompanied by appropriate interventions.[2,3,4] Since 2011,5 National Institute for Health and Care Excellence (NICE) has advocated home blood pressure monitoring as one method of assisting the diagnosis of hypertension, and continues to issue guidance on the use of this method in the updated (2019) guidelines.[6]
The work provides an account of methods used by primary care practitioners in the management of home blood pressure self-m onitoring, where guidance may be lacking and primary care practitioners act on their own judgement
Blood pressure self-m onitoring has been conducted by patients in their own homes for many years, and provides a case from which lessons may be learnt on a variety of aspects of management of patient-owned technologies mobilised in primary care
Summary
The self-m onitoring of blood pressure at home was introduced in the 1930s1, and is associated with improved clinical outcomes in hypertension, when accompanied by appropriate interventions.[2,3,4] Since 2011,5 NICE has advocated home blood pressure monitoring as one method of assisting the diagnosis of hypertension, and continues to issue guidance on the use of this method in the updated (2019) guidelines.[6] home self-m onitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, adherence to NICE guidelines is known to vary.[7] the guidelines do not provide detail on supporting patients to self-monitor, for example, no detail is given regarding advice on purchase or use of a monitor.[5,6].
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