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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

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
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

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.

adherence, fidelity to intervention, persistence, self-management of blood pressure, training and education
0263-6352
1753-1761
Schwartz, Claire L.
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Seyed-Safi, Ashkon
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Haque, Sayeed
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Bray, Emma P.
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Greenfield, Shelia
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Richard Hobbs, F. D.
d27f59e3-f553-442f-9e99-52017410e85e
Little, Paul
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Mant, Jonathan
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Williams, Bryan
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McManus, Richard J.
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Schwartz, Claire L.
3ba63d17-1122-42ed-8f62-cca44c273200
Seyed-Safi, Ashkon
ed1b3cb3-8fa3-4ea4-9b7e-79500676a9cb
Haque, Sayeed
9533ee0d-993f-450d-a5cb-eeedf61337db
Bray, Emma P.
a4338352-cb2e-4589-a0f7-33c1e80b7b39
Greenfield, Shelia
94d1a124-c859-48eb-85da-62610497cfa8
Richard Hobbs, F. D.
d27f59e3-f553-442f-9e99-52017410e85e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Mant, Jonathan
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Williams, Bryan
74a978ee-b2f7-45d5-8f14-7cbe31f22e28
McManus, Richard J.
481f6284-d599-4c77-8869-d1c6b63b9b02

Schwartz, Claire L., Seyed-Safi, Ashkon, Haque, Sayeed, Bray, Emma P., Greenfield, Shelia, Richard Hobbs, F. D., Little, Paul, Mant, Jonathan, Williams, Bryan and McManus, Richard J. (2018) 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. Journal of Hypertension, 36 (8), 1753-1761. (doi:10.1097/HJH.0000000000001738).

Record type: Article

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.

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Accepted/In Press date: 1 March 2018
e-pub ahead of print date: 1 August 2018
Keywords: adherence, fidelity to intervention, persistence, self-management of blood pressure, training and education

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Local EPrints ID: 422892
URI: http://eprints.soton.ac.uk/id/eprint/422892
ISSN: 0263-6352
PURE UUID: 49a1ae8b-c81b-4f9d-9239-0084903981ea

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Date deposited: 07 Aug 2018 16:31
Last modified: 17 Dec 2019 05:17

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Contributors

Author: Claire L. Schwartz
Author: Ashkon Seyed-Safi
Author: Sayeed Haque
Author: Emma P. Bray
Author: Shelia Greenfield
Author: F. D. Richard Hobbs
Author: Paul Little
Author: Jonathan Mant
Author: Bryan Williams
Author: Richard J. McManus

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