Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process...

Area of Science:

• Digital Health Interventions
• Hypertension Management
• Primary Care Research

Background:

• Many hypertension patients exceed target blood pressure, increasing adverse health risks.
• A digital intervention effectively reduced blood pressure over 12 months by prompting medication escalation based on home readings.
• This study evaluated the implementation of this digital intervention in Primary Care.

Purpose of the Study:

• To understand the implementation of a digital intervention for medication escalation in hypertension management.
• To identify mechanisms of action and contextual factors influencing intervention effectiveness.
• To inform future digital health strategies for addressing clinical inertia in hypertension care.

Main Methods:

• Mixed-methods process evaluation of a randomized controlled trial involving 125 healthcare practitioners.
• Quantitative data from digital intervention usage and medical records.
• Qualitative data from semi-structured interviews with 27 practitioners, analyzed thematically.

Main Results:

• Practitioner adherence to medication escalation was moderate (53%), influenced by trust in home readings and need for more evidence.
• Self-efficacy correlated with adherence, but perceived necessity and concerns also played roles.
• Adherence to remote support was mixed, with uncertainty regarding patient responses.

Conclusions:

• The digital intervention provided insights into practitioner decision-making for medication escalation.
• Proposed strategies include enhanced tracking of patient readings and flexible decision-making to combat clinical inertia.
• Improving digital systems with patient acknowledgments could enhance implementation.