Telehealth to Manage Hypertension in General Practice
Telehealth to Manage Hypertension in General Practice
During the evaluation period, 2963 patients from 357 practices (number of patients recruited per practice: minimum = 1, maximum = 104), registered onto an AIM hypertension protocol; nearly half of these patients registered onto AIM01 (n = 1468) (Table 3). Of these, over 50 % achieved the minimum target days of texting over the protocol duration for those registered on AIM01 (83 %) and AIM02 (56 %), however this success criterion was not met for AIM03 (15 %) or AIM10 (47 %).
The pre-defined success criterion for AIM01 was that 100 % of patients using the protocol were confirmed as having hypertension or not. This success criterion was not met as the mean BP could only be calculated for 1166/1468 (79 %) patients who registered on the protocol. However, of those for whom a diagnosis of hypertension could be confirmed/refuted, 740 (63 %) were found to have a mean BP in the hypertensive range (≥135/85 mm Hg).
Success criteria for the hypertension monitoring protocols, AIM02, AIM03 and AIM10, were that BP had become controlled by the end of protocol use in a pre-defined proportion (75–80 %) of patients (Table 1). However, the proportions outlined in the success criteria were not reached for any of the monitoring protocols (5–22 %) (Table 4).
Only patients who were sent, and then responded to, the first evaluative question were sent the second patient evaluation question. Responses to the first evaluative question, the adapted friends and family question, are described elsewhere. The majority of patients responding to the second evaluative question (82–97 %) agreed that they were more confident in taking their BP (AIM01) and understanding their BP (AIM02, AIM03, AIM10) at each time point for each protocol (see Table 5). However, these proportions represented only 9–54 % of the total number of patients ever registered on each protocol, due to non-response to the initial evaluation question, poor response to the second evaluation question (AIM03) and evaluative texts not being sent to patients. Clinical telehealth facilitator intelligence suggests that clinicians discontinued patients' protocols when patients had dropped out or the purpose of the protocol had been met (e.g. presence of hypertension confirmed or refuted; blood pressure adequately controlled); this sometimes occurred before the next monthly evaluative series of texts were sent to patients.
Only patients who responded to the second question were sent the third evaluative question. At each time point, most respondents on AIM01, AIM02 and AIM10 (93–98 %) agreed that they preferred to send their BP readings into their general practice via Florence, rather than consulting in person. Of responding patients on AIM03, at least 89 % of patients reported that they took their tablets regularly and this increased to 97 % by month three (Table 6). However, again, these proportions represented only 9–50 % of the total number of patients ever registered on each protocol, due to the reasons outlined above.
Results
Protocol use
During the evaluation period, 2963 patients from 357 practices (number of patients recruited per practice: minimum = 1, maximum = 104), registered onto an AIM hypertension protocol; nearly half of these patients registered onto AIM01 (n = 1468) (Table 3). Of these, over 50 % achieved the minimum target days of texting over the protocol duration for those registered on AIM01 (83 %) and AIM02 (56 %), however this success criterion was not met for AIM03 (15 %) or AIM10 (47 %).
Diagnosis of Hypertension
The pre-defined success criterion for AIM01 was that 100 % of patients using the protocol were confirmed as having hypertension or not. This success criterion was not met as the mean BP could only be calculated for 1166/1468 (79 %) patients who registered on the protocol. However, of those for whom a diagnosis of hypertension could be confirmed/refuted, 740 (63 %) were found to have a mean BP in the hypertensive range (≥135/85 mm Hg).
Control of Hypertension
Success criteria for the hypertension monitoring protocols, AIM02, AIM03 and AIM10, were that BP had become controlled by the end of protocol use in a pre-defined proportion (75–80 %) of patients (Table 1). However, the proportions outlined in the success criteria were not reached for any of the monitoring protocols (5–22 %) (Table 4).
Patient User Feedback
Only patients who were sent, and then responded to, the first evaluative question were sent the second patient evaluation question. Responses to the first evaluative question, the adapted friends and family question, are described elsewhere. The majority of patients responding to the second evaluative question (82–97 %) agreed that they were more confident in taking their BP (AIM01) and understanding their BP (AIM02, AIM03, AIM10) at each time point for each protocol (see Table 5). However, these proportions represented only 9–54 % of the total number of patients ever registered on each protocol, due to non-response to the initial evaluation question, poor response to the second evaluation question (AIM03) and evaluative texts not being sent to patients. Clinical telehealth facilitator intelligence suggests that clinicians discontinued patients' protocols when patients had dropped out or the purpose of the protocol had been met (e.g. presence of hypertension confirmed or refuted; blood pressure adequately controlled); this sometimes occurred before the next monthly evaluative series of texts were sent to patients.
Only patients who responded to the second question were sent the third evaluative question. At each time point, most respondents on AIM01, AIM02 and AIM10 (93–98 %) agreed that they preferred to send their BP readings into their general practice via Florence, rather than consulting in person. Of responding patients on AIM03, at least 89 % of patients reported that they took their tablets regularly and this increased to 97 % by month three (Table 6). However, again, these proportions represented only 9–50 % of the total number of patients ever registered on each protocol, due to the reasons outlined above.
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