title: Patient self-monitoring of blood pressure and self-titration of medication in primary care: the TASMINH2 trial qualitative study of health professionals' experiences.
abstract: BACKGROUND
  Self-monitoring with self-titration of antihypertensives leads to reduced blood pressure. Patients are keen on self-monitoring but little is known about healthcare professional views.
  
  
  OBJECTIVE
  To explore health professionals' views and experiences of patient self-management, particularly with respect to future implementation into routine care.
  
  
  METHODS
  Qualitative study embedded within a randomised controlled trial of healthcare professionals participating in the TASMINH2 trial of patient self-monitoring with self-titration of antihypertensives from 24 West Midlands general practices.
  
  
  METHODS
  Taped and transcribed semi-structured interviews with 13 GPs, two practice nurses and one healthcare assistant. Constant comparative method of analysis.
  
  
  RESULTS
  Primary care professionals were positive about self-monitoring, but procedures for ensuring patients measured blood pressure correctly were haphazard. GPs interpreted home readings variably, with many not making adjustment for lower home blood pressure. Interviewees were satisfied with patient training and arrangements for blood pressure monitoring and self-titration of medication during the trial, but less sure about future implementation into routine care. There was evidence of a need for training of both patients and professionals for successful integration of self-management.
  
  
  CONCLUSIONS
  Health professionals wanted more patient involvement in hypertension care but needed a framework to work within. Consideration of how to train patients to measure blood pressure and how home readings become part of their care is required before self-monitoring and self-titration can be implemented widely. As home monitoring becomes more widespread, the development of patient self-management, including self-titration of medication, should follow but this may take time to achieve.
authors.affiliation: Primary Care Clinical Sciences and NIHR School for Primary Care Research, University of Birmingham, Birmingham.
authors.forename: Miren I
authors.initials: MI
authors.lastname: Jones
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
authors.forename: Emma P
authors.initials: EP
authors.lastname: Bray
authors.forename: Fd Richard
authors.initials: FR
authors.lastname: Hobbs
authors.forename: Roger
authors.initials: R
authors.lastname: Holder
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D004739:England / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011320:Primary Health Care; D036301:Qualitative Research; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents