Hypertension is a common problem among the adult population. Thus, the role of out-patient clinics is to teach patients to self-monitor their blood pressure regularly to prevent hypertension. Telehealth and telemedicine are effective means of primary care used by primary care nurses, health assistants, general practitioners, and patients to measure blood pressure in a clinic or at home. Telemonitoring is an important and helpful technology that can be used in out-patient clinics for primary care with a focus on the teach-back method for patients’ self-management of hypertension. Although this technology may require some additional resources and time needed to teach both clinicians and patients to use it, it will help prevent uncontrolled hypertension, predict cardiovascular risk, reduce the cost of long-term care, and reduce the necessity to attend the clinic as often as patients did before.
The current paper will focus on the use of telemonitoring as a means to gather and analyze patient home-monitored blood pressure readings. The first section of the paper will provide a precis of the peer-reviewed scholarly article written by Hammersley et al. (2020). The purpose of this part is to introduce the readers to an integrated telemonitoring system and demonstrate how this system can be used in the primary care unit. The next part will introduce the mind map and discuss this mind map, basing on the reviewed article and other peer-reviewed sources. The conclusion section will summarize the main ideas of the paper and support the main argument.
Precis
The article “Telemonitoring at Scale for Hypertension in Primary Care: An Implementation Study” by Hammersley et al. (2020) was published in PLoS Med peer-reviewed journal. This quasi-experimental implementation study explored the feasibility and impact of the use of an integrated telemonitoring system for hypertension management and measurement in routine primary care. The article is arranged in the following way. First, the authors provide background information about hypertension and discuss the role of self-monitoring and telemonitoring in primary care. The study was conducted in Lothian, Scotland (Hammersley et al., 2020, p. 4). The researchers describe the logic model for the Scale-Up BP (blood pressure) telemonitoring system and deployment (p. 4). Hammersley et al. (2020) collected data from the patients in the eight practices and compared the results with those who did not use self-monitoring at home (p. 6). The study involved 905 patients who had complete data at baseline within the last 6-12 months (p. 8).
The study results demonstrated that the number of face-to-face appointments decreased by 15% in the year after the implementation of the telemonitoring system (Hammersley et al., 2020, p. 9). With the beginning of telemonitoring, patients’ systemic blood pressure lowered, and clinicians began to respond to changes faster (p. 12). The number of anti-hypertensive prescriptions increased mostly for patients who lived in deprived areas and those whose BP was above 135 mm Hg (p. 12). Both patients and clinicians found the implementation of telemonitoring system helpful.
The information in the article is important for the out-patient clinic for primary care with a focus on the teach-back method for patients’ self-management of hypertension because it demonstrates the main advantages of the telemonitoring system in such clinics. This information can be used to show how the new technology can improve BP control, decrease the number of face-to-face appointments, save patients’ and clinicians’ time, and prevent uncontrolled hypertension. Finally, the article shows that such barriers to the implementation of telehealth as lack of confidence in new technology, fears of workload, lack of time to learn something new, and skepticism about the efficiency of the system can be overcome easily (Hammersley et al., 2020, p. 13).
Mind Map Discussion
Telemonitoring systems can be used in the out-patient clinic for primary care in the following ways. Since the out-patient clinic focuses on the teach-back method for patients’ self-management of hypertension, telemonitoring can be used as a patient education method (See Appendix). It is of high importance to educate patients how to self-monitor their blood pressure. If patients are not aware of how to use telemonitoring and demonstrate their distrust of the system, they will be frustrated and demonstrate negative health outcomes eventually (Lu et al., 2019, p. 36).
Telemonitoring allows performing mentoring and achieving advanced home health care because it connects patients and their primary care practitioners (See Appendix). With the help of teleconsultation and videoconferencing, clinicians can teach patients how to measure and record their blood pressure (Omboni, 2019, p. 2). Moreover, virtual visits may substitute face-to-face appointments when the case is not serious and can be solved online (See Appendix). As Hammersley et al. (2020) write, telemonitored groups decreased the number of face-to-face consultations compared to those patients who did not use the new technology (p. 10). It happened mostly because of the quick clinicians’ responses to the patients’ measurements.
Telemonitoring systems can be used to prescribe medicines, regulate dosage, and consult patients about their health when needed (See Appendix). For example, when patients’ blood pressure increases, their health care provider receives a notification and may regulate the dosage of prescribed medicines or change the prescription immediately. Such remote consulting “removes geographical distances and potentially reduces socioeconomic gaps,” saves time on traveling, and improves convenience (Car et al., 2017, p. 3). The study by Hammersley et al. (2020) showed that the average “number of days from first systolic BP ˃ 160mm Hg or ˂ 90 mm Hg appearing in the medical record […] to clinical review and action […] was 13” (p. 12). Although this result is not perfect, it is still better than the absence of any response due to the lack of patient self-monitoring.
In addition, telemonitoring systems can be used to store and forward information and share data with other professionals (See Appendix). Research showed that blood pressure telemonitoring systems (BPTs) in conjunction with cointervention (intrusion and consultation of another specialist, consultant, or case assistant) led to “significantly larger and persistent (up to 12 months) BP reductions than self BP-monitoring alone without transmission of BP data and counseling” (Parati et al., 2018, p. 1130). One can see that telehealth in general, and telemonitoring systems in particular, can be effectively used in primary care to prevent uncontrolled hypertension, reduce cardiovascular risk, and improve patient health outcomes.
Conclusion
Telemonitoring systems are effective means of gathering information about patients’ BP in real-time. Such systems save patients’ and clinicians’ time and money, reduce the cost of long-term care, prevent hypertension, and help minimize the risk of cardiovascular diseases. Having reviewed the study by Hammersley et al. (2020) and other peer-reviewed sources, one can conclude that telemonitoring has many advantages and should be implemented in the current out-patient clinical setting to deal with hypertension management. If clinicians educate and mentor patients before introducing the system to them and assist them during the use, the outcomes will be positive for all stakeholders. Finally, telemonitoring systems help to provide high-quality health care and improve patients’ self-management, effectively preventing negative consequences of hypertension.
References
Car, J., Tan, W. S., Huang, Z., Sloot, P., & Franklin, B. D. (2017). eHealth in the future of medications management: Personalization, monitoring and adherence.BMC Medicine, 15(73), 1-9. Web.
Hammersley, V., Parker, R., Paterson, M., Hanley, J., Pinnock, H., Padfield, P., Stoddart, A., Park, H. G., Sheikh, A., & McKinstry, B. (2020). Telemonitoring at scale for hypertension in primary care: An implementation study.PLoS Med, 17(6), 1-19. Web.
Lu, J.-F., Chen, C.-M., & Hsu, C.-Y. (2019). Effect of home telehealth care on blood pressure control: A public healthcare centre model. Journal of Telemedicine and Telecare, 25(1), 35-45. Web.
Omboni, S. (2019). Connected health in hypertension management.Frontiers in Cardiovascular Medicine, 6(76), 1-17. Web.
Parati, G., Dolan, E., McManus, R. J., & Omboni, S. (2018). Home blood pressure telemonitoring in the 21st century. Journal of Clinical Hypertension, 20, 1128-1132. Web.
Appendix
