Morag Hearty Programme Manager
Lesley Aitken Programme Assistant
Helen Alexander Report Compilation
Rapid Improvement Study: Hypertension Monitoring in General Practice
Many people are asked to attend their GP or Practice Nurse for the sole reason to have their blood pressure monitored and do not benefit in any other way from the visit. NHS Lanarkshire conducted a study with the aim to asses the benefits and challenges of remotely monitoring patients’ blood pressure by using home health monitoring (HHM), with the use of a simple text messaging technology (Flo). The study involved 115 patients over a 90 day period within 14 GP practices throughout North and South Lanarkshire.
To be able to measure the effectiveness of the study; clinical contact, clinical decision-making and patient experience were measured throughout the study period. They found the average number of contacts avoided were 4.4 due to the use of HHM, and a total of 416 appointments were avoided releasing a considerable amount of patient and clinical time.
Clinicians were asked questions about monitoring being an aid to decision-making, those who responded agreed that it was and it helped to generate faster clinical outcomes. This was due to various reasons for example, HHM identifying ‘white coat syndrome’ in a third of patients that were being monitored, which may have led to mis-diagnosis of hypertension, however it also confirmed the condition in 16 patients. As well as this clinicians were able to adjust medication dosage accordingly or avoided the need for medication at all.
To measure patient experience the 115 participants of the study were sent a series of text messages asking about their experience with Flo. From the people who responded it was found that the majority felt Flo was easy to use, with only one patient having any difficulty using the text messaging software.
They were also asked whether or not Flo helped monitor their blood pressure. Most of the people who responded to this question found Flo helped a lot with only 1 feeling that it made no difference to them.
Finally patients were asked about their willingness to use Flo again in the future, out of those who replied, only 1 person said they were not willing to do so.
From the study NHS Lanarkshire concluded;
HHM of blood pressure improves efficiency as it reduces the amount of appointments needed. This then reduces clinic time for clinicians including contact over the phone and prevents patient travel for routine monitoring.
HHM of blood pressure supports clinical decision-making as it enables faster decision-making by providing optimum readings.
People mostly find it easy to monitor their own blood pressure and report results by text and would use it again in future if needed.
Based on the very positive results obtained, roll-out of this improvement cycle is definitely warranted. Reports of the success achieved have spread and other practices have now expressed an interest. However, there are a number of additional sources of evidence that it would be useful to collate, to expand the range of benefits realised. For example, in the longer-term it would be possible to explore any changes in medication use for these patients and to compare individual patient journeys before and after use of the Home Health Monitoring.
SHARED PROTOCOLS (FLORENCE EXAMPLE LIBRARY)
HYPERTENSION – SCO LAN GP Short BP monitoring survey V2 June 2016
HYPERTENSION – SCO LAN GP BP monitoring with alerts and survey V2