BACKGROUND: Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it. AIM: To explore patients' views of self-monitoring blood pressure and self-titration of antihypertensive medication. DESIGN AND SETTING: Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient self-management of hypertension from 24 general practices in the West Midlands. METHOD: Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method. RESULTS: Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a self-management plan. CONCLUSION: Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.
RCT Entities:
BACKGROUND: Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it. AIM: To explore patients' views of self-monitoring blood pressure and self-titration of antihypertensive medication. DESIGN AND SETTING: Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient self-management of hypertension from 24 general practices in the West Midlands. METHOD: Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method. RESULTS:Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a self-management plan. CONCLUSION:Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.
Authors: Beverly B Green; Andrea J Cook; James D Ralston; Paul A Fishman; Sheryl L Catz; James Carlson; David Carrell; Lynda Tyll; Eric B Larson; Robert S Thompson Journal: JAMA Date: 2008-06-25 Impact factor: 56.272
Authors: A J Farmer; A N Wade; D P French; J Simon; P Yudkin; A Gray; A Craven; L Goyder; R R Holman; D Mant; A-L Kinmonth; H A W Neil Journal: Health Technol Assess Date: 2009-02 Impact factor: 4.014
Authors: Peter M Rothwell; Sally C Howard; Eamon Dolan; Eoin O'Brien; Joanna E Dobson; Bjorn Dahlöf; Peter S Sever; Neil R Poulter Journal: Lancet Date: 2010-03-13 Impact factor: 79.321
Authors: Matthew E Allen; Taya Irizarry; Julian Einhorn; Thomas W Kamarck; Brian P Suffoletto; Lora E Burke; Bruce L Rollman; Matthew F Muldoon Journal: Patient Educ Couns Date: 2019-06-17
Authors: Virginia MacNeill; Caroline Sanders; Ray Fitzpatrick; Jane Hendy; James Barlow; Martin Knapp; Anne Rogers; Martin Bardsley; Stanton P Newman Journal: Br J Gen Pract Date: 2014-07 Impact factor: 5.386
Authors: E P Bray; M I Jones; M Banting; S Greenfield; F D R Hobbs; P Little; B Williams; R J Mcmanus Journal: J Hum Hypertens Date: 2015-01-08 Impact factor: 3.012
Authors: Benjamin R Fletcher; Lisa Hinton; Emma P Bray; Andrew Hayen; Fd Richard Hobbs; Jonathan Mant; John F Potter; Richard J McManus Journal: Br J Gen Pract Date: 2016-08-30 Impact factor: 5.386
Authors: Richelle J Koopman; Bonnie J Wakefield; Jennifer L Johanning; Lynn E Keplinger; Robin L Kruse; Marilee Bomar; Beth Bernt; Douglas S Wakefield; David R Mehr Journal: Telemed J E Health Date: 2013-12-18 Impact factor: 3.536
Authors: R J McManus; S Wood; E P Bray; P Glasziou; A Hayen; C Heneghan; J Mant; P Padfield; J F Potter; F D R Hobbs Journal: J Hum Hypertens Date: 2013-07-04 Impact factor: 3.012
Authors: Flory L Nkoy; Bryan L Stone; Bernhard A Fassl; Karmella Koopmeiners; Sarah Halbern; Eun H Kim; Justin Poll; Joseph W Hales; Dillon Lee; Christopher G Maloney Journal: AMIA Annu Symp Proc Date: 2012-11-03
Authors: Katherine Morton; Laura Dennison; Carl May; Elizabeth Murray; Paul Little; Richard J McManus; Lucy Yardley Journal: Patient Educ Couns Date: 2016-10-20