A qualitative process study: Lessons learned from implementing a digital intervention for managing hypertension in Primary Care

Problem

High blood pressure accounts for up to 12% of GP consultations in the UK, and yet many patients taking antihypertensive medication remain poorly controlled. A digital self-management intervention has the potential to save resources and improve clinical outcomes in this population. The online HOME BP intervention supports Primary Care Practitioners to manage patients with poorly controlled blood pressure remotely, prompting pre-planned medication changes when home blood pressure readings are too high. This intervention requires the adoption of potentially new or challenging behaviours by healthcare practitioners, such as remote support and medication change without seeing or speaking to the patient in real time. This qualitative process study aimed to explore the experiences of GPs and nurses using the HOME BP intervention, in order to understand possible barriers to implementation and how these could be addressed.

Approach

This was a qualitative process evaluation nested within a randomised controlled trial in UK Primary Care. In-depth telephone interviews were conducted with 27 nurses and GPs from 19 different Practices. Inductive thematic analysis was used to analyse the data, enabling us to discover the most salient and important implications for the users implementing the intervention. This is line with a person-based approach to intervention evaluation.

Findings

Four themes were developed which described GPs’ and nurses’ experiences of using the HOME BP intervention: Belief in the concept of HOME BP as a management tool in Primary Care; Challenges and benefits of supporting patients remotely; Reluctance to change antihypertensive medication; and Ease or burden of implementing the intervention in daily practice. GPs were happy to rely on home readings to manage patients’ blood pressure, but experiences of pre-planning medication changes and initiating medication change remotely were varied, with some GPs finding this very straightforward and efficient whilst others were concerned about following this process in case of over-medicalisation. Nurses found email templates a useful tool for supporting patients, although some wanted more opportunity to track patients’ progress in the programme to help them feel more involved in their patients’ care.

Consequences

The findings helped us to understand how we could improve the HOME BP intervention to promote adherence to target procedures across healthcare practitioners. The findings have implications for wider implementation of digital interventions in Primary Care, such as how to minimise the burden on GPs supporting tele-monitoring interventions, and how to overcome barriers to initiating changes to treatment.