1. Digital interventions to manage hypertension: general practitioners perspectives
Eimear C. Morrissey1, Liam G. Glynn2, Monica Casey2, Jane C. Walsh1 & Gerry J. Molloy1
1School of Psychology, National University of Ireland, Galway School of Medicine, National University of Ireland, Galway
Method
Sample & Recruitment
GPs from the west of Ireland were recruited purposively based on age, sex, years of practice, practice size and practice location (urban/rural). Ten interviews were conducted in total. Recruitment continued until data saturation was reached and no new themes emerged.
Background
Hypertension control through pharmacological treatment has led to substantial benefits in the prevention of morbidity and mortality from cardiovascular diseases. However, evidence from a number of studies suggests that as many as 50% to 80% of patients treated for hypertension have low adherence to their treatment regimen. Digital behavioural interventions could potentially be a useful modality for hypertension control. While it is important to examine the use and effectiveness of these technological interventions at a patient level, it is also crucial to examine them at a practitioner level. The majority of hypertension care happens at general practice.
Aim
This research aims to (1) explore general practitioners (GPs) experience of managing antihypertensives, including the use of guidelines and resources available and (2) elicit GPs attitudes towards the use of technology to support adherence behaviour change.
Interviews
The interview schedule was developed by reviewing other qualitative research in the area. These were then discussed with the research team and piloted on one GP. The interviews were semi-structured and carried out by one researcher (EM) who travelled to the GPs’ clinics.
Analysis
The five stage of thematic analysis (familiarisation, generation of codes, searching for themes, reviewing themes and defining themes) were followed. To heighten reflexivity, four members of the research team (two health psychologists, a GP and a nurse) joined the lead researcher to review all the data and contribute to the thematic analysis.
Findings
“Well, yes of course if you are aware of it. But I don’t think your responsibility is to check on people’s BP while they’re out in the pub or the café or something like that. I’m probably a bit old fashioned and I believe in people taking charge of their own affairs to a fair extent.”
Male, 72
“Because people who are already health aware and health anxious may not be the best candidates – you mightn’t suggest it. But then there are some who would be very interested in having a shared care approach to their medical problems but are also not going to get too anxious, they’d definitely be great candidates so it depends a little bit, yeah.”
Female, 37
Valid measurements vs lack of regulation and evidence
Data empowers
Disruption of traditional relationship
“Worried well”
Selecting patients
Generation gap
Where is the division?
Movement of responsibility
Safety
Responsibility
Current Reach
Opportunity and cost
Empowerment
“If a very high BP reading was sent in and we might be getting that information without being able to contact the patient. So you might have something that needs action and needs to be acted on and then if you’re not able to get in contact with that person. It sounds great but there are some aspects to it that would probably lead to some GPs having reservation with it..”
Male, 50
“I think it would work for a certain patient group – obviously you need to be smartphone savvy - am, which isn’t most of the hypertension group.”
Male, 38
“Patients are using technology and accessing information and its not necessarily always the right information. Yeah you would certainly want to know what they are actually using.”
Female, 33
“But the other side to it is, you would be all for empowering patients and for them being more aware of their BP or just in particular if they are trying to implement lifestyle changes and can see a result in it.”
Female, 37
“So with a medication reminder you would expect that their compliance would be better because they feel more involved and that they have ownership of it. I think, it also is good because we know that the gold standard for measuring BP is the ABPM, the office BP is probably the least accurate and your home diary or BP record is kind of in the middle then. So it provides an additional form of measuring - so it beneficial for the patient and doctor so that it not only helps with compliance but also there is a more accurate measurement record as well.”
Male, 37
“Yeah well any time I sit down with a hypertensive patient, I’m conscious of the fact that whenever I take their BP as a spot reading in the office, it’s often hopelessly inaccurate. So anything we can do to make better clinical decisions around that I think we should welcome. So for example I would always encourage people to bring in their latest set of results to me and always do some monitoring before they come into me.”
Male, 44
Conclusion
Primary care has a significant role in managing hypertension. GPs in this study discussed several barriers and possible solutions to integrating digital interventions for hypertension management. Future research should evaluate the effectiveness of using digital interventions alongside traditional primary care to manage hypertension and identify models of best practice.
@EimearMorrissey