The impact of a nurse-led telemetric home blood pressure monitoring service in stroke or transient ischaemic attack (TIA).
We know that if people who have previously suffered a stroke or TIA keep good control of their blood pressure (BP), they will be much less likely to have problems in the future.
Using modern mobile technology, people can now easily take these measurements at home using a new kind of meter and send them to a secure website so that only they and their doctor or nurse can see the results.
Their doctor or nurse can then make changes to their treatment if needed. Monthly printed summaries of blood glucose and blood pressure results can be sent to patients.
If patients use the internet, they can also see their record on the website and receive automatic feedback by email.
We aimed to find out if using these new kind of meters really helps people to control their blood pressure, or if using it is too much trouble.
We carried out a randomised controlled feasibility trial with nested qualitative interview study.
Trial participants were split into 2 groups. We gave one group the new meters and the other group were looked after in the usual way.
After 6 months, we measured blood pressure in both groups to see if people using the new meters had better control of their blood pressure.
We recruited 55 people to the feasibility trial to investigate whether we can do a larger study to find out which is better.
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.
- What is the participation rate in the pilot trial?
- What is the response rate to patient information?
- How disabled are those who respond, and how does this affect their ability to use the equipment?
- What proportion of those willing to be randomised already have optimally controlled blood pressure on daytime ambulatory monitoring?
- Are the proposed recruitment and randomisation procedures appropriate for this patient group?
- What is the level of compliance with the intervention amongst people recruited to the trial?
- What proportion of those in the active arm:
- provide regular readings (at least weekly) without help?
- provide regular readings (at least weekly) with help?
- provide less regular readings or stop using the equipment?
- What is the variation in the proposed outcome measures for the large-scale trial?
- What are the experiences and opinions of people who have had a stroke / TIA of this service (including impact on behaviour, mood, positive and negative experiences and change in relationship with their healthcare provider)?
- What are healthcare providers’ experiences and opinions of this service?
- How might the intervention be improved to meet the specific needs of people with stroke / TIA?
Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%) patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two participants (95%) attended the 6-month follow-up appointment, but one declined the second daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93% completion rate for ABPM − the proposed primary outcome measure for a full trial.
Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38 continued to provide readings throughout the 6 months. There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group, which suggested the potential for a substantial effect from telemonitoring.
Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement, was easy, convenient and reassuring.
Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA) (Trials, 2015):
The development of a Stroke Patient Panel to advise on the development of the research:
Involving patients in clinical research: the Telescot Patient Panel (Health Expectations, 2013)
|Funders||Chief Scientist Office, with additional funding for equipment from Chest Heart and Stroke Scotland|
|Chief Investigator||Dr Janet Hanley|
|Trial Manager||Allison Todd|
Protocol of the study: