Digital BP self-monitoring project 'to reduce demands on general practice'

A self-monitoring scheme for patients with hypertension in Scotland aims to improve diagnosis and management while reducing demands on frontline GPs and practice nurses.

21 May 2018, by Siobhan Chan

A woman takes her blood pressure

Bill Fletcher, 67, was enjoying an active retirement after over 40 years in the steel industry – until he went for a blood pressure (BP) check that revealed his BP was too high.

“I’d felt absolutely fine – that was the scary thing about it,” says the grandfather of four and passionate football fan from Hamilton, South Lanarkshire. “I had no idea I had high blood pressure and the consequences of that, if it was left unchecked, could have been significant.

“I was relieved the problem was identified but at first I wondered how this diagnosis – and the need for regular checks and appointments – would affect my lifestyle.”

Fortunately, Bill was able to maintain his active life with minimal trips to his GP surgery thanks to an expanding digital self-monitoring project underway in parts of Scotland.

Home monitoring

The scheme across NHS Lanarkshire, NHS Lothian and NHS Western Isles seeks to improve patient self-management of hypertension while reducing demands on GP and practice nurse time spent on face-to-face BP monitoring.

Patients with hypertension are given, and taught to accurately use, home blood pressure monitors (HBPMs) and invited to report their readings via text message every day using their mobile phone.

The general practice team can access the readings to help manage patients’ hypertension and some patients are also offered advice and support via text message.

If the readings are a cause for concern, patients are prompted to take action, such as retake their measurement or contact their GP or other health professional for a face-to-face appointment.

It is hoped this system can minimise the need for face-to-face appointments in general practice, allowing more time to attend to more complex patient needs.

Improved diagnosis

Hypertension rarely causes symptoms, so routine checks for at-risk patients are important to identify cases that could otherwise be missed.

To help diagnose hypertension while reducing the number of face-to-face appointments in general practice, the three health boards are providing at-risk patients with an HBPM to record and report their BP via text message.

The scheme forms part of an existing strand of the Scottish Government’s £30 million Technology Enabled Care (TEC) programme, which began in 2014.

Under this strand, at least 4,000 patients across 150 general practices are now using the text message-based system FLORENCE to deliver this BP service, as of December 2017.

The BHF is contributing £100,000 in funding alongside £119,000 from the TEC programme to extend this project to reach an additional 3,000 patients over two years.

This includes joint funding for the equivalent of two Band 4 whole time equivalent health promotion (telehealth) assistants – who will support the roll-out and use of the system across the three health boards – and the purchase of an extra 300 BP monitors.

Encouraging spread and adoption

Supervised telemonitoring has been shown to improve outcomes in the management of high BP, according to Professor Brian McKinstry, Professor of eHealth at The University of Edinburgh and Clinical Lead for the project.

“Our research now focuses on the best way to implement these findings into routine practice so that people become more involved in managing their own BP and, critically, in a way that does not increase workload for frontline staff,” he said.

Richard Forsyth, Health Service Engagement Lead at BHF Scotland, added: “The evidence from this project will be used to support the spread and adoption of this model across Scotland.”

Bill Fletcher 

Meanwhile, Bill (pictured above) says the programme has given him peace of mind that he is ‘linked in’ to healthcare professional support.

“The system is so easy to use and has made all the difference to me and my family,” he says. “And that lets me get on with the important things in life – visiting my parents, who are both in their nineties, seeing my grandchildren, and supporting my football team, Motherwell!”

Nearly 30% of adults in Scotland are thought to have high BP, and a BHF analysis has shown that optimally treating all these people could prevent 880 strokes and 590 heart attacks over the next three years.

The partnership between BHF Scotland and the three NHS Boards is being led by NHS 24’s Scottish Centre for Telehealth and Telecare and supported by the TEC programme.

The BHF is providing a total of £1.5 million in funding to multiple BP projects across the UK over the next three years. These will develop innovative models of care to improve detection and self-management of hypertension.

Find out how we can do more in Scotland to improve prevention of cardiovascular disease.

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