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Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial

Objective To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinically important reductions in daytime systolic and diastolic ambulatory blood pressure in p...

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Autores principales: McKinstry, Brian, Hanley, Janet, Wild, Sarah, Pagliari, Claudia, Paterson, Mary, Lewis, Steff, Sheikh, Aziz, Krishan, Ashma, Stoddart, Andrew, Padfield, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663293/
https://www.ncbi.nlm.nih.gov/pubmed/23709583
http://dx.doi.org/10.1136/bmj.f3030
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author McKinstry, Brian
Hanley, Janet
Wild, Sarah
Pagliari, Claudia
Paterson, Mary
Lewis, Steff
Sheikh, Aziz
Krishan, Ashma
Stoddart, Andrew
Padfield, Paul
author_facet McKinstry, Brian
Hanley, Janet
Wild, Sarah
Pagliari, Claudia
Paterson, Mary
Lewis, Steff
Sheikh, Aziz
Krishan, Ashma
Stoddart, Andrew
Padfield, Paul
author_sort McKinstry, Brian
collection PubMed
description Objective To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinically important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure. Design Multicentre randomised controlled trial. Setting 20 primary care practices in south east Scotland. Participants 401 people aged 29-95 years with uncontrolled blood pressure (mean daytime ambulatory measurement ≥135/85 mm Hg but ≤210/135 mm Hg). Intervention Self measurement and transmission of blood pressure readings to a secure website for review by the attending nurse or doctor and participant, with optional automated patient decision support by text or email for six months. Main outcome measures Blinded assessment of mean daytime systolic ambulatory blood pressure six months after randomisation. Results 200 participants were randomised to the intervention and 201 to usual care; primary outcome data were available for 90% of participants (182 and 177, respectively). The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg (95% confidence interval 2.0 to 6.5; P=0.0002) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg (0.9 to 3.6; P=0.001), with higher values in the usual care group. The intervention was associated with a mean increase of one general practitioner (95% confidence interval 0.5 to 1.6; P=0.0002) and 0.6 (0.1 to 1.0; P=0.01) practice nurse consultations during the course of the study. Conclusions Supported self monitoring by telemonitoring is an effective method for achieving clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources. Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective. Trial registration Current Controlled Trials ISRCTN72614272.
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spelling pubmed-36632932013-05-28 Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial McKinstry, Brian Hanley, Janet Wild, Sarah Pagliari, Claudia Paterson, Mary Lewis, Steff Sheikh, Aziz Krishan, Ashma Stoddart, Andrew Padfield, Paul BMJ Research Objective To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinically important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure. Design Multicentre randomised controlled trial. Setting 20 primary care practices in south east Scotland. Participants 401 people aged 29-95 years with uncontrolled blood pressure (mean daytime ambulatory measurement ≥135/85 mm Hg but ≤210/135 mm Hg). Intervention Self measurement and transmission of blood pressure readings to a secure website for review by the attending nurse or doctor and participant, with optional automated patient decision support by text or email for six months. Main outcome measures Blinded assessment of mean daytime systolic ambulatory blood pressure six months after randomisation. Results 200 participants were randomised to the intervention and 201 to usual care; primary outcome data were available for 90% of participants (182 and 177, respectively). The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg (95% confidence interval 2.0 to 6.5; P=0.0002) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg (0.9 to 3.6; P=0.001), with higher values in the usual care group. The intervention was associated with a mean increase of one general practitioner (95% confidence interval 0.5 to 1.6; P=0.0002) and 0.6 (0.1 to 1.0; P=0.01) practice nurse consultations during the course of the study. Conclusions Supported self monitoring by telemonitoring is an effective method for achieving clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources. Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective. Trial registration Current Controlled Trials ISRCTN72614272. BMJ Publishing Group Ltd. 2013-05-24 /pmc/articles/PMC3663293/ /pubmed/23709583 http://dx.doi.org/10.1136/bmj.f3030 Text en © McKinstry et al 2013 http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
spellingShingle Research
McKinstry, Brian
Hanley, Janet
Wild, Sarah
Pagliari, Claudia
Paterson, Mary
Lewis, Steff
Sheikh, Aziz
Krishan, Ashma
Stoddart, Andrew
Padfield, Paul
Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title_full Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title_fullStr Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title_full_unstemmed Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title_short Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
title_sort telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663293/
https://www.ncbi.nlm.nih.gov/pubmed/23709583
http://dx.doi.org/10.1136/bmj.f3030
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