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Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation

Kate Morton Orcid Logo, Laura Dennison, Becky Band Orcid Logo, Beth Stuart, Laura Wilde, Tara Cheetham-Blake, Elena Heber, Joanna Slodkowska-Barabasz, Paul Little, Richard J. McManus, Carl R. May, Lucy Yardley, Katherine Bradbury

Implementation Science, Volume: 16, Issue: 1

Swansea University Author: Becky Band Orcid Logo

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DOI (Published version): 10.1186/s13012-021-01123-1

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BackgroundA high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’...

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Published in: Implementation Science
ISSN: 1748-5908
Published: Springer Science and Business Media LLC 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa67026
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A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’ home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation.MethodsOne hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients’ medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol.ResultsMean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients.ConclusionsThis mixed-methods process evaluation provided novel insights into practitioners’ decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients’ readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. 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spelling v2 67026 2024-07-09 Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation 06b53a31f254b004de8649a376ce2fbd 0000-0001-5403-1708 Becky Band Becky Band true false 2024-07-09 HSOC BackgroundA high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’ home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation.MethodsOne hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients’ medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol.ResultsMean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients.ConclusionsThis mixed-methods process evaluation provided novel insights into practitioners’ decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients’ readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. Implementation of one-way notification systems could be facilitated by enabling patients to send a brief acknowledgement response. Journal Article Implementation Science 16 1 Springer Science and Business Media LLC 1748-5908 Mixed methods, Process evaluation, Hypertension, Blood pressure, Normalisation Process Theory, Digital intervention 26 5 2021 2021-05-26 10.1186/s13012-021-01123-1 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University This independent research was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1211-20001). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. 2024-09-02T15:03:26.5415468 2024-07-09T15:22:14.6657101 Faculty of Medicine, Health and Life Sciences School of Psychology Kate Morton 0000-0002-6674-0314 1 Laura Dennison 2 Becky Band 0000-0001-5403-1708 3 Beth Stuart 4 Laura Wilde 5 Tara Cheetham-Blake 6 Elena Heber 7 Joanna Slodkowska-Barabasz 8 Paul Little 9 Richard J. McManus 10 Carl R. May 11 Lucy Yardley 12 Katherine Bradbury 13 67026__31227__fb47e40a6f7d4311bf483451c85c1719.pdf 67026.VoR.pdf 2024-09-02T15:02:25.9293486 Output 1550908 application/pdf Version of Record true This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
spellingShingle Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
Becky Band
title_short Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
title_full Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
title_fullStr Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
title_full_unstemmed Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
title_sort Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation
author_id_str_mv 06b53a31f254b004de8649a376ce2fbd
author_id_fullname_str_mv 06b53a31f254b004de8649a376ce2fbd_***_Becky Band
author Becky Band
author2 Kate Morton
Laura Dennison
Becky Band
Beth Stuart
Laura Wilde
Tara Cheetham-Blake
Elena Heber
Joanna Slodkowska-Barabasz
Paul Little
Richard J. McManus
Carl R. May
Lucy Yardley
Katherine Bradbury
format Journal article
container_title Implementation Science
container_volume 16
container_issue 1
publishDate 2021
institution Swansea University
issn 1748-5908
doi_str_mv 10.1186/s13012-021-01123-1
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
active_str 0
description BackgroundA high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’ home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation.MethodsOne hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients’ medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol.ResultsMean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients.ConclusionsThis mixed-methods process evaluation provided novel insights into practitioners’ decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients’ readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. Implementation of one-way notification systems could be facilitated by enabling patients to send a brief acknowledgement response.
published_date 2021-05-26T15:03:25Z
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