Patient experiences of remote hypertension management during covid-19: a qualitative study

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): British Heart Foundation. Background Telemonitoring of blood pressure [BP] managed within primary care is effective in reducing the risk of cardiovascular disease in patients with hypertension. However, COVID-19 disrupted service delivery and affected the support of people living with hypertension. It is unknown how patients who did or did not utilise telemonitoring self-managed their BP during the pandemic. Purpose To understand patients’ experience of hypertension service delivery in Scotland during the COVID-19 pandemic, with a focus on the use of remote BP telemonitoring technology. Methods Qualitative individual semi-structured telephone interviews were conducted between April and November 2022. Interview transcripts were analysed using the framework approach to code and categorise the data into key concepts and overarching themes. Results We interviewed 43 participants (23 males and 20 females) from 6 primary care practices. From the views of 25 patients utilising telemonitoring technology and 18 who did not, we identified five overarching themes that represented participants' experiences of hypertension services delivery during the COVID-19 pandemic. 1) Adapting NHS services. Covid-19 disrupted routine services and resulted in infrequent in-person health checks for BP, asthma, and diabetes for both groups and a lack of primary care feedback for non-telemonitored patients’ home-monitored BP. 2) Navigating access to services. Gaining timely and/or in-person access to services was challenging. Also there was fear and delay in access because it was viewed as a source of covid infection. 3) Telemonitoring. Remote telemonitoring permitted telemonitoring participants to continue receiving hypertension management during the pandemic. 4) Self-management of BP. Some non-telemonitoring participants were motivated to self-measure BP readings using home monitoring equipment to increase self-care for hypertension and lifestyle. Also, some telemonitoring participants were empowered to self-manage medication changes. 5) Experiences of covid. Upon contracting the covid-19 virus, some participants experienced an immediate increase in their BP, and post-virus, longer-term increased BP readings and/or feelings of chest discomfort and breathlessness. Conclusions The covid-19 pandemic disrupted care for patients with hypertension and although it was clear that service delivery had been adapted, patients were unwilling to access the NHS due to covid-19 risk and found access to effective primary care support difficult. When compared to non-telemonitoring, telemonitoring provided a more direct link to the primary care team who were able to manage hypertension remotely. The service disruption may have longer-term implications for patient health outcomes; however, this study suggests there is greater scope for self-management of hypertension than currently recommended.