Do Patients with Uncontrolled Hypertension Sustain High Quality Self-Blood Pressure Monitoring after an Interactive Workshop

Problem

International guidelines including the European Society of Hypertension (EHS) and National Institute for Health and Clinical Excellence (NICE) recommended appropriate use of self-blood pressure monitoring (SBPM) in patients with uncontrolled blood pressure (BP). Studies found that patients who used SBPM had better BP control as they were more engaged in disease management. The main barriers to SBPM are technical difficulty (multiple steps) and hardware problem (unvalidated SBPM devices). The study centers serve mainly the elderly and those with financial needs. We test if the practice of SBPM through interactive education workshops is sustainable and beneficial to patients.

Approach

This is a multicenter interventional study. Patients from 3 general practices with office BP > 140/90mmHg, who were able and willing to perform SBPM were invited to attend a 2-hour interactive workshop. Their drug compliance was assessed by the validated 8-item Morisky’s Medication Adherence Scale (MMAS-8). Their health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. The rundown of workshop was listed below: (1) lecture of basic HT knowledge and drug information; (2) video demonstration of SBPM procedure; (3) nurse demonstration BP measurement; (4) loaning and trial of SBPM device; (5) assessment of patients if they could follow all 10 steps of SBPM correctly. Patients were instructed to record home BP twice daily in the subsequent 7 days, followed by twice weekly. A standard SBPM record book was issued. Patients were followed up by nurses individually 4-6 weeks later to reassess their habit of SBPM, their SBPM technique and the quality of BP records.

Findings

Fifteen workshops were completed in 3 clinics from April to August 2016. Of the 151 eligible patients (mean age = 66, S.D. 9.7, M: F =0.57) attended, 84.1% of them had uncomplicated hypertension. Their MMAS-8 score showed only 41.1% of them had good drug compliance, while 22.5% of them had low drug compliance. 37.1% of them had inadequate health literacy. All of them return demonstrated the 10 steps of SBPM immediate after workshop. 130 (86.1%) patients attended the nurse follow up 4-6 weeks later. 72% of them continue SBPM and 56% of them had their own validated SBPM machine. They reported better drug compliance (MMAS ≥6, which signify moderate to high compliance) (OR 2.46, 95%C.I. 1.02-5.96, p=0.045 and OR 2.47, 95%C.I. 1.04-5.86, p=0.037 respectively) when compared with those did not perform SBPM. For the 46 participants not yet bought their own device, 91% wanted to continue borrowing SBPM device from clinic. 86% of participants demonstrated all correct steps of SBPM.

Consequences

Most patients were willing to continue SBPM, which was associated with better drug compliance. Loaning validate device to patients and structured workshop can promote high quality SBPM.