Hypertension
The impact of a telemetric hypertension monitoring service: a randomised controlled trial with nested qualitative study.
Context
Lowering blood pressure substantially reduces an individual’s risk of having a stroke or heart attack.
Aims
We investigated:
-
whether changing NHS services to support this type of self care helped reduce blood pressure for hypertensive patients
-
whether it improved patient knowledge and sense of empowerment around blood pressure control
-
what users thought of the service
Method
We undertook research using both qualitative and quantitative methods.
We conducted a randomised controlled trial (RCT) involving recruitment of 400 people with high blood pressure: 200 continued receiving usual care and the other 200 were given a blood pressure monitor to use at home, which transmits readings via mobile phone to a secure website which can be accessed by themselves and their practice nurse who can give advice by telephone, text or email.
We also interviewed a proportion of participants to explore their experience of self−monitoring, the sources of support they used and any unintended consequences of self monitoring.
Research questions
-
Is there any reduction in average blood pressure and other specific cardiovascular risk factors in the group using the telemetric home blood pressure monitoring service compared to a control group that receive usual care?
-
Is there any difference in adherence to lifestyle advice (smoking, diet, alcohol and salt intake, exercise) compared with a control group?
-
Is there any difference in the number and type of contacts with primary care amongst the group using telemetric home blood pressure monitoring compared with a control group?
-
What are people’s experiences and opinions of this service including impact on behaviour, mood, positive and negative experiences and change in relationship with their health care provider?
-
What are health care providers’ experiences and opinions of this service?
Results
200 participants were randomised to the intervention and 201 to usual care; primary outcome data were available for 90% of participants (182 and 177, respectively). The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg (95% confidence interval 2.0 to 6.5; P=0.0002) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg (0.9 to 3.6; P=0.001), with higher values in the usual care group.
The intervention was associated with a mean increase of one general practitioner (95% confidence interval 0.5 to 1.6; P=0.0002) and 0.6 (0.1 to 1.0; P=0.01) practice nurse consultations during the course of the study. Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient.
Patients generally liked the intervention. Patients using telemonitoring became more engaged in the clinical management of their condition. Professionals reported that telemonitoring challenged existing roles and work practices and increased workload. Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback.
Conclusions
Supported self monitoring by telemonitoring is an effective method for achieving clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources.
Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective.
Papers
Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study (BMJ Open, 2013)
| Funder | The Bupa Foundation |
| Chief Investigator | Dr Janet Hanley |
| Trial Manager | Mary Paterson |
Additional information
Protocol:
