Key result
BP self-management with self-titration earns primary care physician support for broader patient use.
Why the study?
Hypertension remains uncontrolled in over 50% of European patients despite home BP monitoring, and the views of primary care doctors regarding BP self-management with medication self-titration needed exploration.
Primary care doctors in Spain are supportive of blood pressure self-management and self-titration, though they identify a need for clear interprofessional collaboration, particularly with nursing staff.
Physician comfort with BP self-titration supports acceptance; leaves open optimal interprofessional protocols before practice change.
BACKGROUND: Despite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension. AIM: To explore the views and attitudes of primary care doctors participating in the ADAMPA trial regarding BPSM with self-titration. DESIGN & SETTING: A focus group study took place with primary care doctors participating in the ADAMPA trial, which was carried out in one health district of the Valencia Health System in Spain. METHOD: Nine primary care doctors participating in the ADAMPA trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics. RESULTS: Participating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control. CONCLUSION: Primary care doctors participating in the ADAMPA trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.
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Marco-Moreno et al. (2020) studied Uncontrolled hypertension (n=9). Blood pressure self-management (BPSM) with self-titration was evaluated. Primary care doctors participating in the ADAMPA trial feel comfortable with blood pressure self-management with self-titration and would consider extending its use to other patients.
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