Patient Engagement in a Hybrid Care Pathway for Hypertension: Not One Size Fits All

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=15). Intervention: Hypertension hybrid care pathway (physical care, proactive home blood pressure telemonitoring via Luscii app, digital lifestyle intervention, and digital communication tool). Primary outcome: Patient experiences, usability (TUQ and MAUQ scores), and future needs for long-term engagement across digital elements.

Q: What does this research mean for the field?

Participation in a hybrid care pathway for hypertension improves patient disease insight and engagement across age groups, but sustained engagement requires personalized digital elements and direct clinician interactions tailored to age-specific needs. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Job van Steenkiste; Iris Verberk-Jonkers; Stéphanie de Koning; Joyce Voss-de Haan; Bianca de Jong-Verhagen; Daan Dohmen

doi:10.1177/23743735241297626

January 1, 2024Journal of Patient ExperienceOpen Access

Patient Engagement in a Hybrid Care Pathway for Hypertension: Not One Size Fits All

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Key result

Hybrid hypertension care improves disease insight and engagement across age groups, though personalization remains necessary.

n=15

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Why the study?

Current experiences and future needs for long-term patient engagement in a hypertension hybrid care pathway required evaluation.

Key Points

To evaluate patient experiences and future requirements for long-term engagement across distinct age groups participating in a hypertension hybrid care pathway.
Conducted focus groups in March 2023 and applied deductive thematic content analysis across remote monitoring, communication, and digital lifestyle intervention domains.
Assessed technology acceptance using the Telehealth Usability Questionnaire (TUQ) and mHealth App Usability Questionnaire (MAUQ) on a 1–7 Likert scale.
Participation improved disease insight, engagement, and shared decision capabilities across all age groups, with all patients requesting more personalized approaches and direct interaction with their healthcare providers.
Patients older than 65 years preferred simplifying the telemonitoring application to its primary measurement transmission function, whereas younger groups requested enrichment with more complex disease and lifestyle information.
Questionnaires showed median TUQ scores of 4 [IQR 4-4] for group 1, 6 [IQR 5-6] for group 2, and 5 [IQR 4-6] for group 3, with median MAUQ scores of 4 [IQR 3-4], 6 [IQR 5-6], and 6 [IQR 5-6], respectively.

Study Design

Type

Observational (n=15)

Multicenter

No

Structured PICO

P

Population

15 Dutch-speaking adults with hypertension (60% female, divided into 18-40, 40-65, and >65 age groups) participating in a hybrid care pathway for at least 3 months (range 4-21 months) at a single center in the Netherlands.

E

Exposure

Hypertension hybrid care pathway combining physical outpatient consultations with three digital elements via the Luscii telemonitoring application: (1) proactive home blood pressure telemonitoring (HBPT) with Bluetooth blood pressure monitors, twice morning and twice evening measurements (daily, biweekly, or monthly schedules), and threshold-triggered alerts reviewed Monday-Friday by specialized e-nurses; (2) asynchronous digital messaging integrated with the electronic health record; and (3) a digital lifestyle intervention (B1-level educational modules, automated BMI calculation, and integrated pedometer) over 4-21 months of prior participation.

O

Outcome

Current experiences and future needs for long-term patient engagement across the digital elements (remote monitoring, digital communication, digital lifestyle intervention) evaluated via deductive thematic content analysis of 2-hour focus group interviews, alongside Telehealth Usability Questionnaire (TUQ) and Mhealth Usability Application Questionnaire (MAUQ) scores.patient reported

To sustain long-term patient engagement in hybrid hypertension care pathways, digital telemonitoring and lifestyle tools must be tailored to age-specific preferences—simplifying apps for older adults while enriching content for younger patients—and maintain personal interaction with familiar healthcare providers.

Limitations

Data saturation was not completely reached due to participation of 15 of the originally intended 21 patients (most evident in group 1).
Selection bias, as only engaged (positive or critical) patients were likely to participate, limiting generalizability to less involved patients.
Dividing focus groups into three separate age groups resulted in age-specific findings that do not apply to the entire pathway population.
Potential social desirability bias inherent to focus group interviews.
Results were analyzed from the complete group perspective using audio transcripts rather than individual perspectives with video transcripts.
Single-center evaluation at Maasstad Hospital limits generalizability across other hybrid care pathways for hypertension.
Data saturation was not completely reached due to participation of 15 of the originally intended 21 patients (most evident in group 1)
Selection bias as only engaged (positive or critical) patients were likely to participate, limiting generalizability for less involved patients
Division into three separate age groups produced age-specific findings that do not apply to the entire care pathway population
Potential for social desirability bias in focus group interviews
Analysis was conducted from the perspective of the complete group using audio transcripts rather than individual perspectives with video transcripts
Single-center evaluation at Maasstad Hospital limits generalizability to other hybrid care pathways

Implication

May enhance engagement in hybrid hypertension care; leaves open optimal age-specific digital personalization in larger trials.

Abstract

We evaluated current experiences and future needs for the long-term engagement of patients in a hypertension hybrid care pathway (Maasstad Hospital, NL). Patients >18 y/o with ≥3 months care pathway participation were recruited by telephone and divided into three age/focus groups with distinct digital skills and attitudes toward lifestyle interventions (group 1:18-40 y/o, group 2:40-65 y/o, group 3:>65 y/o). We used deductive thematic content analysis to cluster the results to the different digital elements (remote monitoring, communication, digital lifestyle intervention) of the care pathway. Fifteen patients were interviewed in March 2023 (Group 1;2;3, 3;6;6 participants). The care pathway improved disease insight, engagement, and shared decision capabilities in all groups. For further improved adherence and engagement, all patients indicated the need to incorporate a more personalized approach and interaction with their healthcare provider. In addition, the oldest group preferred simplification of the telemonitoring application, while the other groups preferred enrichment with more complex information. To ensure optimal engagement, digital elements in hybrid care pathways should be personalized and tailored to individual as well as to age-specific needs.

Discussion

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Cite This Study

Steenkiste et al. (2024) conducted an observational in Hypertension (n=15). Hypertension hybrid care pathway (physical care, proactive home blood pressure telemonitoring via Luscii app, digital lifestyle intervention, and digital communication tool) was evaluated on Patient experiences, usability (TUQ and MAUQ scores), and future needs for long-term engagement across digital elements. Participation in a hypertension hybrid care pathway improved disease insight and engagement across all age groups (n=15, median TUQ 4-6/7), though patients needed personalized digital care.

synapsesocial.com/papers/6a7483c0b172e98d88f53ed2 https://doi.org/10.1177/23743735241297626

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Patient Engagement in a Hybrid Care Pathway for Hypertension: Not One Size Fits All

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Patient Engagement in a Hybrid Care Pathway for Hypertension: Not One Size Fits All

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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