Implementation of home blood pressure monitoring among French GPs: A long and winding road

Abstract

BackgroundTo explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice.MethodsA qualitative study comprising the conduct of six focus groups between October 2016 and February 2017, gathering 41 general practitioners in primary care practice in Lorraine (North Eastern France), with thematic and comprehensive analysis.ResultsThe first reasons given by GPs to explain their difficulties with HBPM (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources. However, all of these motives masked other substantial limiting factors including insufficient knowledge regarding HBPM, poor adherence to recommendations on HBPM and fear of losing their medical authority. GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia. Despite this observation, most GPs used HBPM only at the time of diagnosis and rarely for follow-up. One explanation for GP reluctance towards HBPM may be, along with guidelines regarding hypertension, HBPM is perceived as being a binding framework and being difficult to implement. This barrier was more predominantly observed among aging GPs than in young GPs and was less frequent when GPs practiced in multidisciplinary health centers because the logistical barrier was no longer present.DiscussionIn order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. We must also end "medical power" in hypertension management and turn to multidisciplinary care including nurses, pharmacists and patients.

Home blood pressure monitoring in France: Device possession rate and associated determinants, the Esteban study

“…In France, a growing number of health professionals are proposing HBPM to their hypertensive patients. 8 We found a positive association between visiting a GP and possessing a HBPM device among those aware of their hypertension. This highlights the importance of health professionals, and especially GP, in the management of this condition.…”

“…Simply possessing a HBPM device is not enough; it must also be used and data must be shared with medical doctors. 8,28,29 Although participants in the Esteban study were asked about possessing (or not) a HBPM device, no data were collected on whether they used them. This could explain the absence of expected relationships between adherence to treatment and control of hypertension.…”

“…5 Many previous studies have highlighted that Home Blood Pressure Monitoring (HBPM) is useful in improving BP control, treatment adherence, the detection of white coat and masked hypertension, and prognosis. [6][7][8][9][10] Consequently, European and French guidelines suggest the use of HBPM in the diagnosis and therapeutic management of hypertension. 4,5 In a study in the United Kingdom, over 30% of aware hypertensive patients reported HBPM and 60% performed it at least monthly.…”

Home blood-pressure measurement for the diagnosis and monitoring of arterial hypertension by French general practitioners: a cross-sectional survey in the Auvergne region

“…Two web-based surveys in the UK confirmed that GPs have become more likely to use HBPM to diagnose hypertension since the introduction of new national guidance in 2011 [ 23 , 24 ]. Some studies also found a wider use of HBPM to diagnose hypertension by young GPs, those working in groups or MHC, and clinical tutors [ 10 , 12 ]. These are probably important factors in the promotion of HBPM.…”

“…To our best knowledge, there are no data available on the practice of HBPM for the Auvergne region. The barriers to the use of HBPM are numerous, but the cost of the device and non-reimbursement seem to be an important one [ 8 , 12 ]. Since 2013, the French National Health Insurance Body (FNHIB) has taken measures to promote the use of HBPM among General practitioners (GPs).…”