In their discussion of the complex issues around supporting self-care in general practice, Greaves and Campbell state that a prerequisite is ‘… that the initiative has the full support of the healthcare team.’1 We agree that this is a key to achieving optimal care. Our recent experience in the early stage of a community-based trial of home blood pressure monitoring highlights the importance of involving both patients and their GPs.
We are currently carrying out a randomised controlled trial in 360 patients who have had a stroke. The aim is to see if home blood pressure monitoring with nurse-led support is associated with lower systolic blood pressure after 1 year. Three foundation year two doctors helped with the initial planning of the trial and implementation of the pilot study.
Twenty baseline home visits were carried out with 10 patients randomised to the intervention group and given home blood pressure monitors. One month follow-up visits showed that patients had few problems using their home blood pressure monitors and knew that their target for home blood pressure is <130/80 mmHg2 (as we printed this on labels which were stuck to monitors). However, when patients initially consulted their GPs and showed them their recordings of consistently well over-target home blood pressures, no changes were made to their antihypertensive treatment.
We have therefore developed additional trial information to post to participants' GPs. This includes information on home blood pressure targets (10/5 mmHg lower than clinic blood pressure2) and current antihypertensive guidelines.2 We also developed information for patients with a note for their GP to facilitate discussion about blood pressure targets and to support home blood pressure monitoring. Preliminary reports from both GPs and patients suggest this has been beneficial and led to agreed treatment changes and improved blood pressure control.
As Greaves and Campbell point out, ‘Only a minority of people with hypertension achieve target levels for control’. Stroke patients are often highly motivated to consider self-care interventions which will reduce their risk of having another stroke. For those who wish to monitor their blood pressure at home, the support and involvement of the primary health care team is crucial.
Acknowledgments
Funding was provided by the Stroke Association and The Isaac Shapira Trust.
- © British Journal of General Practice, 2007.
