چکیده (انگلیسی):

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.