Do patients actually do what we ask: patient fidelity and persistence to the Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups blood pressure self-management intervention.


Change log
Authors
Schwartz, Claire L 
Seyed-Safi, Ashkon 
Haque, Sayeed 
Bray, Emma P 
Greenfield, Shelia 
Abstract

OBJECTIVE: Self-management of hypertension can reduce and control blood pressure (BP) compared with clinic monitoring. However, self-management relies on patients following an algorithm, which may be variably adhered to. This study reports fidelity of high-risk patients to the self-management algorithm set by the TASMIN-SR trial. METHODS: Patients with hypertension, above target clinic BP and one or more of stroke, diabetes, coronary heart disease or chronic kidney disease, were invited to self-monitor following an individualized self-titration algorithm. Home BP readings and medication change details were submitted monthly for 12 months. Readings downloaded from patients' electronic monitors were compared with written submissions, and protocol fidelity was assessed. RESULTS: Two hundred and seventy-six patients were randomized to self-management and 225 (82%) completed the required training sessions. Of these, 166 (74%) completed self-management. A total of 11385 (89.6%) submitted readings were accurate compared with corresponding downloaded monitor readings. Mean error rate was 5.2% per patient, which increased with age but not comorbidities. Patients made 475 of 683 (69.5%) algorithm-recommended medication changes, equating to nearly three medication changes per patient. Mean SBP for patients who completed training and made all recommended changes dropped from 141 mmHg (95% CI 138.26-144.46) to 121 mmHg (95% CI 118.30-124.17 mmHg) compared with 129 mmHg (95% CI 125.27-136.73 mmHg) for patients who made none. CONCLUSION: Most patients randomized to self-management completed training; however, 36% of these had dropped out by 12 months. Self-monitoring was largely undertaken properly and accurately recorded. Fidelity with self-management was associated with lower achieved SBP. Successful implementation of self-management into daily practice requires careful training and should be accompanied by monitoring of fidelity.

Description
Keywords
Adult, Aged, Algorithms, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Coronary Disease, Diabetes Mellitus, Humans, Hypertension, Middle Aged, Patient Compliance, Renal Insufficiency, Chronic, Self Care, Stroke
Journal Title
J Hypertens
Conference Name
Journal ISSN
0263-6352
1473-5598
Volume Title
36
Publisher
Ovid Technologies (Wolters Kluwer Health)
Sponsorship
National Institute for Health Research (NIHR) (via University of Oxford) (RP-PG-1209-10051 (R McManus))
National Institute for Health Research (NIHR) (via University of Oxford) (unknown)
National Institute for Health Research (NIHR) (via University of Oxford) (unknown)
This report presents independent research funded by the National Institute for Health Research (NIHR). Funding: The TASMIN-SR trial was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG 0606–1153) and by the NIHR National School of Primary Care Research (NSPCR 16). C.S. is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust.