Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study

Jacob A Andrews; Kate Weiner; Catherine M Will; Flis Henwood; Jon M Dickson

doi:10.3399/bjgpopen20X101101

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study

BJGP Open. 2020 Dec 15;4(5):bjgpopen20X101101. doi: 10.3399/bjgpopen20X101101. Print 2020 Dec.

Authors

Jacob A Andrews^{1

2}, Kate Weiner³, Catherine M Will⁴, Flis Henwood⁵, Jon M Dickson⁶

Affiliations

¹ Department of Sociological Studies, University of Sheffield, Sheffield, UK jacob.andrews@nottingham.ac.uk.
² Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
³ Department of Sociological Studies, University of Sheffield, Sheffield, UK.
⁴ School of Law, Politics and Sociology, University of Sussex, Brighton, UK.
⁵ School of Applied Social Science, University of Brighton, Brighton, UK.
⁶ Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK.

Abstract

Background: Home self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.

Aim: To elicit primary care practitioners' experiences of managing patients' home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.

Design & setting: A qualitative focus group study was conducted with a total of 21 primary care professionals.

Method: Participants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed.

Results: Themes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients' data; and effect of socioeconomic factors.

Conclusion: The work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.

Keywords: focus groups; general practitioners; hypertension; practice nurses; primary health care; qualitative methodology; self-monitoring; vignettes.