title: Implementation of simple telehealth to manage hypertension in general practice: a service evaluation.
abstract: BACKGROUND
  Hypertension is common and conveys significant risk of morbidity and mortality. However, inadequate control of hypertension is common. Following a successful local use of a simple telehealth intervention ('Florence') for the diagnosis and management of hypertension, the Advice & Interactive Messaging (AIM) for Health simple telehealth programme was launched across England in March 2013. Four protocols were developed to diagnose and monitor blood pressure (BP). The aim of this service evaluation was to identify the extent to which predefined service outcomes, regarding ascertainment of a diagnosis of hypertension, and achievement of hypertension control, were met for the hypertension protocols.
  
  
  METHODS
  Patients with opportunistic raised BP in general practice or diagnosed hypertension were selected by their usual primary care providers to register onto diagnostic or monitoring hypertension protocols, respectively. Florence sent patients prompts via text messaging to submit readings, educational messages and user satisfaction questions. Patient responses were stored on Florence for review by their primary care health providers. This service evaluation used data from 2963 patients from general practices across England registered onto one of four AIM hypertension protocols from inception to January 2014. Data were extracted from Florence and underwent descriptive analysis.
  
  
  RESULTS
  1166/1468 (79 %) patients were eligible to have a diagnosis of hypertension confirmed/refuted, of which 740 (63 %) had a mean BP in the hypertensive range from one week's readings. BP control was achieved by only 5-22 % of 1495 patients signed up to one of the three monitoring protocols. Patient engagement with the monitoring protocols was initially good but reduced over time.
  
  
  CONCLUSIONS
  Although simple telehealth may be an acceptable tool for diagnosing and monitoring hypertension among responding patient users, and can have a useful role in diagnosis of hypertension (particularly if ambulatory blood pressure monitoring (ABPM) is not possible or is declined), problems were identified. Reduced patient engagement over longer periods and acceptance of suboptimal BP control among patients on monitoring protocols need to be urgently addressed. Empirical work is required to identify barriers to achieving BP control among hypertensive patients using simple telehealth and, consequently, services be developed to address these issues.
authors.affiliation: Trentham Mews Medical Centre, Eastwick Crescent, Trentham, Staffordshire, ST4 8XP, UK. Elizabeth.Cottrell2@northstaffs.nhs.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cottrell
authors.affiliation: NHS Stoke-on-Trent Clinical Commissioning Group, Herbert Minton Building, 79 London Road, Stoke-on-Trent, Staffordshire, ST4 7PZ, UK. Tracey.Cox@staffordsurroundsccg.nhs.uk.
authors.forename: Tracey
authors.initials: T
authors.lastname: Cox
authors.affiliation: NHS Stoke-on-Trent Clinical Commissioning Group, Herbert Minton Building, 79 London Road, Stoke-on-Trent, Staffordshire, ST4 7PZ, UK. phil.oconnell@nhssimple.uk.
authors.forename: Phil
authors.initials: P
authors.lastname: O'Connell
authors.affiliation: NHS Stoke-on-Trent Clinical Commissioning Group/West Midlands Academic Health Science Network, Herbert Minton Building, 79 London Road, Stoke-on-Trent, Staffordshire, ST4 7PZ, UK. Ruth.Chambers@stoke.nhs.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Chambers
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002985:Clinical Protocols; D004739:England; D058006:General Practice / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration
chemical_list: D000959:Antihypertensive Agents