Qualitative data from a trial of home blood pressure telemonitoring and pharmacist management (Hyperlink) [abstract]
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Background/Aims: Hyperlink was a cluster-randomized intervention trial in HealthPartners clinics from 2009 to 2013 with nonintervention follow-up through 2015 (60 months). Participants had uncontrolled hypertension. Telemonitoring intervention patients had improved blood pressure control at 6 months compared with usual care patients (72% vs. 45%, P<0.001). Intervention effects narrowed at 12 (72% vs. 53%, P=0.005) and 18 months (72% vs. 57%, P=0.003); 60-month blood pressure data will be complete in October 2015. We conducted a mixed-methods analysis combining our quantitative results with patient, clinical and other organizational stakeholder perspectives to learn how to optimize the intervention for the most patients and implement this intervention in our care setting. Methods: We collected three sources of qualitative data: seven patient focus groups stratified by 6.18-month blood pressure outcomes, four structured interviews with intervention pharmacists, and interviews (currently being collected) with key organizational stakeholders. Focus group and structured interview data were analyzed by a team of five using grounded theory. Initial themes were identified and coded in NVivo10. Results: Qualitative data revealed several initial themes. First, patients valued trust in the patient-provider relationship and good communication between providers. Second, patients have varying goals with medications and successfully initiating/adhering to treatment is better when provider understands and respects the patient's perspective on medications. Finally, intervention patients benefited from seeing their own blood pressure data (reinforcement) and a trusted provider seeing their data (accountability). Pharmacist interviews agreed with these themes, revealing key insights about intervention design including: length of intervention, addressing relapse, and meeting individual patients' needs with effective use of data and lifestyle counseling. Results of 60-month blood pressure outcomes will be analyzed in the context of these initial findings, and qualitative findings will be further refined. Stakeholder interview results about implementation are forthcoming. Conclusion: Findings suggest the need for several adaptations to the intervention before implementation in practice: provision of blood pressure monitors for ongoing use, a shorter duration with ability to re-engage if blood pressure becomes uncontrolled, more tailoring of the intervention to individual needs, and better communication and handoffs between pharmacists and physicians.