Telemonitoring at scale for hypertension in primary care: an implementation study

Vicky Hammersley, Richard Parker, Mary Paterson, Janet Hanley, Hilary Pinnock, Paul Padfield, Andrew Stoddart, Hyeon Gyeong Park, Aziz Sheikh, Brian McKinstry

Research output: Contribution to journalArticlepeer-review

Abstract

Background:
While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, health care systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care.
Methods and findings:
This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and in a sub-group of representative practices, used routinely acquired data for a records based controlled before and after study; plus qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants’ views on features that facilitated or impeded uptake of the intervention.
Seventy-two primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of eight practices (905 patients of whom 427 (47%) were female with median age of 64 (IQR 56 - 70, range 22 – 89), and median SIMD 2012 decile of 8 (IQR 6 – 10), mean systolic BP fell by 6.55mmHg (SD 15.17) and mean diastolic BP by 4.23mmHg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 mins (SD 68.4) compared with 5.5 mins (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integrating these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, younger and more affluent than non-participating patients and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data is limited in terms of completeness and accuracy.
Conclusions:
Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and resulting in similar reductions in BP to large UK trials. Integrating the telemonitoring readings into routine data handling routines was crucial to the success of this initiative.
Original languageEnglish
Article numbere1003124
JournalPLoS Medicine
Volume17
Issue number6
DOIs
Publication statusPublished - 17 Jun 2020

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