Patients' Perspectives of a Multifaceted Intervention With a Focus on Technology

Abstract

Background-Few studies have investigated the effectiveness of multifaceted interventions from the study participants' perspective. We conducted qualitative interviews to understand patients' experiences with a multifaceted blood pressure (BP) control intervention involving interactive voice response technology, home BP monitoring, and pharmacist-led BP management. In the randomized study, the intervention resulted in clinically significant decreases in BP. Methods and Results-We used insights generated from in-depth interviews from all study participants randomly assigned to the multifaceted intervention or usual care (nϭ146) to create a model explaining the observed improvements in health behavior and clinical outcomes. The data were analyzed using qualitative content analysis methods and consultative and reflexive team analysis. Six explanatory factors emerged from the patients' interviews: (1) improved relationships with medical personnel; (2) increased knowledge of hypertension; (3) increased participation in their health care and personal empowerment; (4) greater understanding of the impact of health behavior on BP; (5) high satisfaction with technology used in the intervention; and, for some patients, (6) increased health care utilization. Eighty-six percent of the intervention patients and 62% of the usual care patients stated that study participation had a positive effect on them. Of those expressing a positive effect, 68% (intervention) and 55% (usual care) reached their systolic BP goal. Conclusions-Establishing

Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study

“…In the US study, issues with poor literacy were identified,28 whereas, although the population for the trial which underpinned this study16 was drawn from across the spectrum of social privilege and deprivation in Scotland, this was not a concern raised at any point. In some of the trials of larger interventions incorporating BP telemonitoring,12 17 18 it is hard to unravel the impact of the telemonitoring from the impact of the rest of the intervention. This study, and the trial outcome, suggests that the telemonitoring itself can overcome some of the barriers to an improved BP control.…”

“…This study, and the trial outcome, suggests that the telemonitoring itself can overcome some of the barriers to an improved BP control. The added value of the additional interventions such as pharmacist support12 or medication self-management plans17 needs to be determined. Interestingly, the qualitative study associated with a trial which included telemonitoring and medication self-management suggested that although many participants would be happy to continue with the telemonitoring, few would be happy to continue with the medication self-management plans 13…”

“…Telemonitoring can overcome these measurement issues by allowing patients to take multiple BP readings at home and share them with healthcare professionals in almost real time, potentially providing motivation for improvements in self-care while facilitating professional input if necessary. Although we have been unable to identify previous qualitative studies of telemonitoring in hypertension in a usual care setting, some common themes are emerging from qualitative studies where the self-monitoring was either part of a larger intervention such as specialist nursing support or self-management of medication,12 13 or the patients were simply self-monitoring with no data transmission 1415 The common themes were that patients generally find self-monitoring to be a positive experience which is empowering, reassuring and motivational.…”

Self-monitoring blood pressure in hypertension, patient and provider perspectives: A systematic review and thematic synthesis

“…Following removal of duplicates and title and abstract screening, 45 full text articles were assessed and 12 articles met the selection criteria [15][16][17][18][19][20][21][22][23][24][25][26]. (PRISMA diagram, Fig.…”

Emphasizing Methods in Outcomes Research

“…Examples include articles that report on randomized trials, 1,2 cross-sectional studies, 3 observational cohort studies, 4 economic analyses, 5-7 meta-analyses, 8 systematic reviews, 9,10 prepost designs, 11 simulations, 12 and qualitative research. 13,14 A glance at this content quickly dispels the myth that outcomes research is primarily associated with secondary data analyses and data mining. That type of work, for the appropriate questions and with the appropriate methodological approach, can make important contributions, but is hardly the only study design used by the field.…”