Authors (including presenting author) :
Fung K, Kwong A, Ko W, Chan D, Ng C, Fung F, Li C, Chan S F, Lai Y P, Yeung K K, Chan L K, Su K Y, Yang K Y, Go T T
Affiliation :
Family Medicine and Primary Healthcare, Queen mary Hospital, Hong Kong West Cluster
Introduction :
Elevated blood pressure and uncontrolled blood pressure increase the risk of cardiovascular diseases, which is a significant health concern (Zhou et al., 2018). Blood pressure is usually measured and monitored in the healthcare system by healthcare staff in hospitals or outpatient departments. Recently, home blood pressure monitoring (HBPM) has become increasingly popular in clinical practice (Yarows et al., 2000). It recognised that HBPM can provide more accurate readings and information on blood pressure levels (Kario 2021), leading to better decisions about medication and improved titration of antihypertensive drug treatment (Staessen et al., 2004).
The Continuous Quality Improvement (CQI) Project on HBPM will be implemented within a primary and community care setting to increase patient awareness of the importance of HBPM. This project is a nurse-led program to be designed and comprises a patient educational intervention to explore the implementation of home blood pressure monitoring to increase patient empowerment, self-care, and treatment adherence in primary healthcare. This initiative allows outpatients and community clients, who do not have their blood pressure devices, to actively monitor their BP and take a more proactive role in managing their health. The strategy can enhance patient engagement, reduce the problems associated with monitoring patient measures, and improve health outcomes.
Objectives :
1. To facilitate better home blood pressure control among hypertensive patients in general outpatient clinics and community care.
2. To explore the patient's attitude and habit towards HBPM.
3. To enhance HBPM among hypertensive patients by implementing a comprehensive education program to promote their self-management in blood pressure control.
4. To promote the use of HA GO apps for home blood pressure records in self-health management.
Methodology :
The design of the project is a pilot study. It is a quasi-experimental study that utilises a convenience sample of participants who visited outpatient clinics and community care services. The eligible patients were selected for the study if they were aged 30 or above and did not have their blood pressure device at home. Patients could have the ability to communicate and complete the questionnaire, and self-reported hypertension HT was confirmed by the computer management system (CMS) of the HA hospital. For the exclusion criteria, patients who were diagnosed with dementia or were difficult to communicate with would not be invited to the study. For the inclusion study of HBPM, patients were provided with automatic oscillometric devices and were asked to measure their blood pressure at home following the standardised protocol.
Recruitment took place from 1 March 2024 to 30 September 2024 in the Risk Assessment and Management Clinics, General Outpatient Clinics, and Community Nurse Service (Hong Kong West Cluster). Data collection consisted of face-to-face structured interviews on their socio-demographic information. Their HBPM habit, knowledge, and skills were collected at baseline. After that, basic knowledge of HT, lifestyle modification, and HBPM was presented to participants with leaflets and a video education provided. Participants were trained to use an automatic home BP machine to monitor their own blood pressure and record their reading into the HA Go apps or a record sheet, a return demonstration on the method of measuring technique. Followed up by one and three months, telehealth or telephone interviews were arranged to determine whether attending the HBPM teaching program improved self-efficacy and awareness of the importance of HBPM.
Result & Outcome :
192 participants enrolled in the study and completed the baseline questionnaire and HBPM teaching. 186 participants completed the post-intervention assessment after 1 month via telehealth or telephone follow-up. 6 participants declined to join the post-1 month follow-up because they were busy. The response rate was 96.8%.
According to baseline characteristic information, more than 55% of these patients have other chronic diseases, e.g., diabetes, and hyperlipidaemia as well. This group of patients needed to have better blood pressure control as they are at high risk of having associated complications in the future. 3.6% of the patients were illiterate, and 41.7% had a primary educational level. There was a need to provide more education and reinforce their knowledge of HBPM for our patients. Overall, 92.2% of them had not performed HBPM at baseline assessment, and 67.7% of patients thought HBPM was helpful for blood pressure control. 20.8% of the patients were worried about their blood pressure measurement not being accurate, and 35.4% of the patients lacked the knowledge to perform it. There was room for the promotion of HBPM and self-management among hypertensive patients. Financial issues may be an unneglectable barrier to performing HBPM among low-income patients; however, we may encourage them to access blood pressure monitoring services in other settings if possible.
Related to the pre- and post-intervention assessment of HBPM of patients, 27.6% failed in the pre-intervention assessment of HBPM knowledge. 40.1% of the patients do not know they should not talk while checking their BP and avoid eating or caffeine 30 minutes before BP monitoring. 55.7% failed in the pre-intervention assessment about the skill of HBPM. 32.3% failed to demonstrate placing the arm at heart level and securing the cuff in the correct position.
In the post-intervention assessment after 1 & 3 months, over 90% of the patients get full marks in both knowledge and skill tests. Although there were difficulties in performing post-assessment for 3.2% of patients (dropout cases), the post-assessment result was satisfactory. This demonstrated that the HBPM teaching program in the study was able to deliver essential knowledge and skills of HBPM to patients. 63.5% of the participants purchased HBPM devices and started to perform HBPM after the teaching program. 57.3% of the participants performed recording in myHealth at HA Go apps. Overall, 82.8% of participants felt most satisfaction with the instruction of HBPM.
