Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system

Ulrika Bengtsson, Karin Kjellgren, Inger Hallberg, Mona Lundin, Åsa Mäkitalo, Ulrika Bengtsson, Karin Kjellgren, Inger Hallberg, Mona Lundin, Åsa Mäkitalo

Abstract

Objective: This paper reports on how the clinical consultation in primary care is performed under the new premises of patients' daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients' contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system.

Design: A qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301.

Setting: Four primary health care centers in Sweden.

Subjects: Patients with hypertension (n = 20) and their health care professional (n = 7).

Results: The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients' contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities.

Conclusion: Patients' contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients' and health care professionals' equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management Key points The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations. Self-reporting combined with increased patient-health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life. These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

Keywords: Blood pressure; cellular phone; communication; counseling; life-style; person-centered care; self-report.

Figures

Figure 1.
Figure 1.
Screenshot showing the combined responses to sleep and tiredness over an eight-week period. The content in the hypertension self-management support system is in Swedish. Hence, the content of the figure is translated from Swedish to English.
Figure 2.
Figure 2.
Questions framing the video-analysis sessions.
Figure 3.
Figure 3.
Flowchart of the analysis process.

References

    1. Ong LML, de Haes JCJM, Hoos AM, et al. . Doctor–patient communication: a review of the literature. Soc Sci Med. 1995;40:903–918.
    1. Roter D. The enduring and evolving nature of the patient–physician relationship. Patient Edu Couns. 2000;39:5–15.
    1. Maynard DW. Interaction and Asymmetry in Clinical Discourse. Am J Sociol. 1991;97:448–495.
    1. Mishler EG. The discourse of medicine: the dialectics of medical interviews. Norwood: Ablex; 1984.
    1. Sarangi S, Roberts C.. Talk, work and institutional order: discourse in medical, mediation and management settings. Berlin: Mouton de Gruyter; 1999.
    1. Kjellgren KI, Svensson S, Ahlner J, et al. . Antihypertensive treatment and patient autonomy – the follow-up appointment as a resource for care. Patient Educ Couns. 2000;40:39–49.
    1. Svensson S, Linell P, Kjellgren KI.. Making sense of blood pressure values in follow-up appointments for hypertension. Int J Cardiol. 2008;123:108–116.
    1. Barry CA, Stevenson FA, Britten N, et al. . Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice. Soc Sci Med. 2001;53:487–505.
    1. Guassora AD, Nielsen SB, Reventlow S.. Deciding if lifestyle is a problem: GP risk assessments or patient evaluations? A conversation analytic study of preventive consultations in general practice. Scand J Prim Health Care. 2015;33:191–198.
    1. Ekman I, Swedberg K, Taft C, et al. . Person-centered care-ready for prime time. Eur J Cardiovasc Nurs. 2011;10:248–251.
    1. Beach W. Diagnosing “lay diagnosis”. Text. 2001;21:13–18.
    1. Sabate E, editor. Adherence to long-term therapies. Evidence for action. Geneva, Switzerland: World Health Organization; 2003.
    1. Munger M, Van Tassel B, LaFleur J.. Medication nonadherence: an unrecognised risk factor. Med Gen Med. 2007;47:826–834.
    1. Mancia G, Fagard R, Narkiewics K, et al. . ESH/ECS guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–1357.
    1. Bengtsson U, Kasperowski D, Ring L, et al. . Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: patient and professional perspectives. Blood Press. 2014;23:288–295.
    1. Marshall IJ, Wolfe CD, McKevitt C.. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012;345:e3953.
    1. Bengtsson U, Kjellgren K, Höfer S, et al. . Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: content validity and usability. Blood Press. 2014;23:296–306.
    1. Hallberg I, Ranerup A, Kjellgren K.. Supporting the self-management of hypertension: patients’ experiences of using a mobile phone-based system. J Hum Hypertens. 2016;30:141–146.
    1. Bengtsson U, Kjellgren K, Hallberg I, et al. . Improved blood pressure control using an interactive mobile phone support system. J Clin Hypertens. 2016;18:101–108.
    1. Jordan B, Henderson A.. Interaction analysis: foundations and practice. J Learn Sci. 1995;4:39–103.
    1. Heritage J, Maynard DW.. Analyzing interaction between doctors and patients in primary care encounters In: Heritage J, Maynard DW, editors. Communication in medical care interaction between primary care physicians and patients. New York: Cambridge University Press; 2006.
    1. Derry SJ, Pea RD, Barron B, et al. . Conducting video research in the learning sciences: guidance on selection, analysis, technology, and ethics. J Learn Sci. 2010;19:3–53.
    1. World Medical Association Declaration of helsinki, ethical principles for medical research involving human subjects. 2008.
    1. Bensing J, Tromp F, van Dulmen S, et al. . Shifts in doctor–patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC Fam Pract. 2006;7:62.
    1. Thirsk LM, Clark AM.. What is the ‘self’ in chronic disease self-management? Int J Nurs Stud. 2014;51:691–693.
    1. Greenfield S, Kaplan S, Ware J.. Expanding patient involvement in care effects on patient outcomes. Ann Intern Med. 1985;102:520–528.
    1. Street RL, Millay B.. Analyzing patient participation in medical encounters. Health Commun. 2001;13:61–73.
    1. Aminoff UB, Kjellgren KI. The nurse – a resource in hypertension care. J Adv Nurs. 2001;35:582–589.
    1. Fu Y, Yu G, McNichol E, et al. . The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: a quasi-experimental study. Int J Nurs Stud. 2016;59:197–207.
    1. Sahlsten M, Larsson I, Sjöström B, et al. . An analysis of the concept of patient participation. Nurs Forum. 2008;43:2–11.
    1. Lindblad U, Ek J, Eckner J, et al. . Prevalence, awareness, treatment, and control of hypertension: rule of thirds in the Skaraborg project. Scand J Prim Health Care. 2012;30:88–94.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться