This finding is reflected in the cost of £11/mm Hg reduction, which compares well with £25.66/mm Hg in the HITS trial in Scotland that used a propriety telemonitoring system.47 We would expect such a blood pressure reduction to lead to a longer term impact on cardiovascular events. In the 1930s, in an effort to remedy the hardships Native Americans had faced under U.S. policy, Commissioner of the Bureau of Indian Affairs (BIA) John Collier took advantageâ¦ The probabilities of being cost effective for the intervention against usual care were 87%, 93%, and 97% at thresholds of £20, £30, and £50, respectively. Participants were given online instructions on how to correctly undertake self-monitoring (using an Omron M3 monitor), with a demonstration video.20 Participants were then asked to rehearse self-monitoring for a minimum of seven days and enter these initial readings into HOME BP online before undertaking study procedures. Part of the Daily Mail, The Mail on Sunday & Metro Media Group, Treat yourself to the perfect entertainment bundle with NOW TV's offers, Get a discount code to save on your internet security, Discover a range of promo codes on kitchen appliances, Find Just Eat's special deals and offers this week, Listen to podcasts and books for less with these offers. After we discussed the issue with the sponsor and with the relevant general practitioners, we decided to keep these people in the trial unless they wished to withdraw, and they have been included in the intention-to-treat analysis. Overall, this digital intervention for the management of hypertension that uses self-monitored blood pressure and behavioural techniques has led to better control of blood pressure than usual care. Eligible participants were aged 18 or older with treated hypertension, a mean baseline blood pressure reading (calculated from the second and third blood pressure readings) of more than 140/90 mm Hg, and were taking no more than three antihypertensive drugs. At the end of the trial a medical record review captured prescription of antihypertensive drugs (including any changes) and within trial primary healthcare resource use (primary care and secondary care, including outpatient and inpatient visits). After randomisation, all patients received a blood pressure drug review from a general practitioner or nurse prescriber (prescribers). By Sam Joseph Semon For Dailymail.com. Curtis LB, A. Participants who reported a hypertension drug specific symptom or adverse effect at final follow-up. Results for other subgroups, including sex, baseline blood pressure, deprivation, and history of self-monitoring, were similar between groups; however, it is possible that those with comorbidities gained less from the intervention (systolic blood pressure difference, controlled for age—no comorbidity: −5.1 mm Hg, −8.4 to −1.8 mm Hg; one comorbidity: −0.6 mm Hg, −5.8 to 4.5 mm Hg; multiple comorbidities: −2.0 mm Hg, −11.1 to 7.2 mm Hg). This finding was robust in sensitivity analyses, including complete case analysis, and also when the mean of the second to sixth blood pressure readings was used as the outcome. Remix:Â The 18-year-old raps to a remixed version of the famous theme song to 1990s sitcom The Fresh Prince of Bel-Air. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR for the submitted work; Omron provided the monitors used in the HOME BP study at reduced cost; RJM received BP monitors for research from Omron and is collaborating with them on development of a telemonitoring system as part of the NIHR Oxford and Thames Valley Applied Research Consortium; RJM receives occasional travel and accommodation reimbursement for talks; he does not personally receive any honorariums or consultancy payments; no other relationships or activities that could appear to have influenced the submitted work. More than 500 of the DVLA's 6,000 workers in Swansea have caught coronavirus since March - as workers accuse... Britain's coronavirus cases fall again amid 'scaremongering' row: Scientists play down more deadly variant... People who have received first Covid-19 jab must stay at home for THREE WEEKS, says Jonathan Van-Tam as... Diary of a paramedic: We're now rushing a lot of younger patients into hospital and a father, 45, and... What it's like helping Britain to jab its way to freedom: DR ELLIE CANNON tells how vaccine is bring joy to... Britain delivers a record 480,000 Covid-19 vaccines in a day - putting it on track to hit 15m first doses... Kate Moss jets into curfew-hit Paris for birthday weekend at £2,500-per-night Ritz with her boyfriend... Porton Down scientists are 'confident' that all mutant strains of coronavirus can be beaten with vaccines. UK National Health Service resource use costs included those due to the intervention and those due to changes in drugs and use of other relevant NHS resources. Participants who used the digital intervention were more likely to have their antihypertensive drugs adjusted during the study; this included more changes in dose (relative risk of a dose change, intervention v usual care: 2.0, 95% confidence interval 1.5 to 2.7) and more changes in drugs (relative risk of a drug change, intervention v usual care: 1.5, 1.1 to 1.9; table 4). The funders and sponsor of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. In intervention and usual care groups, decisions about patients’ drugs remained at the prescriber’s discretion at all times. The methods of the HOME BP trial have already been described in detail.14 Briefly, it was an unmasked randomised controlled trial with automated ascertainment of outcome. All participants completed online questionnaires. Nine weeks after participants were allocated to the intervention (judged to be sufficient time for self-monitoring habits to have been implemented), an optional tool became available outlining user selected evidence based lifestyle modifications that target healthy eating, physical activity, losing weight (if appropriate), and salt and alcohol reduction.14 The health behaviours targeted were chosen based on normalisation process theory and took the form of web pages and links.17. Clinical monitoring of these patients would be difficult or impossible.13. The corresponding author (RJM) together with LY, BS, and JR had full access to all the data in the study. This phenomenon has been shown to result in reduced action by clinicians in the face of evidence, in this case of raised blood pressure.4445 Our previous work on self-monitoring and management has also resulted in increased use of antihypertensive drugs, but the data captured here are more detailed than has been previously possible.91046 We used a drug titration algorithm that gave clinicians the opportunity to develop individual treatment plans for their patients, which is in line with national and international guidance.3839 In tandem with reduced clinical inertia, self-management in the context of HOME BP improved patient enablement, and this might also have mediated the effect. Contributors: LY, together with PL and RJM, conceived and led the study, providing detailed supervision of all aspects throughout. Engagement with the digital intervention was high, with 281/305 (92%) participants completing the two core training sessions, 268/305 (88%) completing a week of practice blood pressure readings, and 243/305 (80%) completing at least three weeks of blood pressure entries (table A5). The HOME BP intervention included elements designed to motivate and support healthy behaviours. Julian said of feeling star-struck among his famous colleagues. The groups were well matched, with a mean age of 66 years and mean baseline clinical blood pressure of 151.6/85.3 mm Hg and 151.7/86.4 mm Hg (usual care and intervention, respectively; table 1). Furthermore, 214/305 (70%) were still monitoring in the last three months of participation (of 12 month study). Miscegenation comes from the Latin miscere, "to mix" and genus, "kind". Qualitative process study to explore the perceived burdens and benefits of a digital intervention for self-managing high blood pressure in Primary Care in the UK. Hypertension is the major risk factor for cardiovascular disease internationally and evidence from several randomised controlled trials shows that this risk can be reduced by lowering blood pressure.12 In the United Kingdom, almost 30% of adults have raised blood pressure (≥140/90 mm Hg), with the proportion increasing to more than 50% in people aged 65 and older.3 Target blood pressure levels are reached for less than half of adults, and with an ageing population, novel interventions are required to improve blood pressure control.34, Digital interventions (apps, programmes, or software used in a health context) have the potential to support people in self-management.45 A digital intervention developed by our group that facilitates lifestyle change in primary care patients with obesity resulted in cost effective weight loss.6 However, for patients with hypertension, evidence for digital interventions has been from small trials with relatively short follow-up and substantial heterogeneity of results.7 One trial that lasted longer than 10 months reported that patients’ blood pressure was not reduced.8 We have previously shown that self-monitoring combined with self-titration of antihypertensive drugs is cost effective and leads to considerably lower blood pressure in people with essential hypertension and those at higher risk. Cathy Rice joined as a patient and public contributor during the trial and has remained extensively involved, including optimising many patient facing documents and intervention training content, authorship of this paper and assisting in dissemination. If you are unable to import citations, please contact Dissemination to participants and related patient and public communities: A lay summary of the results of the study will be shared with participating patients and their practices. Analyses were on an intention-to-treat basis and used 100 multiple imputations by chained equations for missing data. Optional additional behavioural support for self-monitoring and lifestyle modifications was available to intervention participants through practice nurses or healthcare assistants (referred to as supporters) by using the CARE (congratulate, ask, reassure, encourage) approach.17 This support comprised up to six brief face-to-face, telephone, or email contacts addressing difficulties associated with self-monitoring or lifestyle change, with additional monthly email support provided by using prewritten templates. However, such implementation will not be possible without some consideration of the factors that influence successful translation into daily practice.51 Some of these factors were successfully addressed in the development of HOME BP, which used extensive user feedback to ensure that healthcare professionals and patients had a shared, positive understanding of the aims and likely benefits of HOME BP, and perceived it as easy and not onerous to use.16171819 Achieving clinician buy-in is more likely to occur once evidence from trials such as ours is incorporated into routine clinical practice guidelines. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial, Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial, Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs, Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England, Normalisation process theory: a framework for developing, evaluating and implementing complex interventions, Telemonitoring at scale for hypertension in primary care: An implementation study, Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial, https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm, http://creativecommons.org/licenses/by/4.0/, https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2017, https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-2018/, https://improvement.nhs.uk/resources/developing-the-national-tariff/, https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/age-groups/latest#age-profile-by-ethnicity, https://www.ofcom.org.uk/__data/assets/pdf_file/0011/113222/Adults-Media-Use-and-Attitudes-Report-2018.pdf, Kent and Medway NHS & Social Care Partnership Trust: Consultant Psychiatrist - The Beacon, Tolsey Surgery: GP Partner in Rural North Wiltshire, H&F Partnership: Salaried GP, West London, 4 to 8 sessions, Royal Devon and Exeter NHS Foundation Trust: Substantive Consultant Physicians in Acute Medicine, Women’s, children’s & adolescents’ health. After 12 months, a post hoc analysis showed that 112/234 (47%) patients in the usual care group reported monitoring their own blood pressure at home at least once per month during the trial; of these, 78 (70%) said that they took their readings to their general practitioner. If mean home blood pressure was controlled for three consecutive months (defined as 100-134/≤84 mm Hg), patients were advised to reduce blood pressure monitoring to once every eight weeks; monitoring reverted back to every month if mean blood pressure subsequently increased above 135/85 mm Hg. The results were similar in the complete case analysis and showed a smaller but still significant effect size when considering the mean of the second to sixth blood pressure readings (table A2). Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The effect size seen in this trial was slightly smaller than, but within the confidence intervals of, our trial that assessed a similar paper based self-management intervention in a similar population. A within trial economic analysis estimated cost per unit reduction in systolic blood pressure—the primary outcome—by using similar adjustments and multiple imputation for missing values as described in the statistical analysis section. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What is an appropriate level of evidence for a digital health intervention? Godzilla Vs. Kong trailer offers epic amounts of action as the monsters go head-to-head in a fresh reimagining. Anonymised trial data from HOME BP are available on reasonable request from the corresponding author. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Proof the Pfizer Covid vaccine works in the real world? This was a large trial of a digital intervention in the field of hypertension and with follow-up for a year. A post hoc analysis showed that blood pressure dropped by at least 5 mm Hg in 201/270 (74.4%) of the intervention group compared with 170/282 (60.3%) of those receiving usual care: adjusted odds ratio for a 5 mm Hg drop: 1.9 (95% confidence interval 1.3 to 2.8; controlling for practice level clustering and stratification factors). Published: 23:59 GMT, 11 January 2021 | Updated: 06:57 GMT, 12 January 2021. By recruiting from a large number of general practices, we ensured generalisability in terms of healthcare professionals. People with diabetes: less than 135/75 mm Hg. Secondary analyses used similar techniques to assess differences between groups. Data are mean (standard deviation) unless stated otherwise, Costs, systolic blood pressure reduction from baseline, and incremental cost per blood pressure reduction by using bootstrap methods based on imputed blood pressure data. We would like to show you a description here but the site wonât allow us. Of the subsample of 243 participants with a body mass index greater than 25, 46 (19%) registered on the online weight loss programme. The within trial analysis for quality of life (EuroQoL-5D-5L) showed no significant difference between the two groups (table 6). Job interview questions and sample answers list, tips, guide and advice. Secondary outcomes (also adjusted for baseline and covariates if appropriate) included systolic and diastolic blood pressure at six and 12 months using second and third blood pressure readings, and second to sixth blood pressure readings; weight; modified patient enablement instrument (patients’ feelings of confidence about understanding their illness and their ability to manage, understand, and cope with their condition; and general health problems that occurred after receiving healthcare)2526; drug adherence (Medication Adherence Rating Scale questionnaire)27; health related quality of life measured with the EuroQoL-5D-5L28; and side effects from the symptoms section of an adjusted illness perceptions questionnaire.29. Post hoc analyses are stated. The study used minimisation to reduce important baseline imbalance and this has the potential to reduce the effect of randomisation. Ofcom. Six and 12 months after randomisation, participants attended follow-up appointments with an independent research nurse where blood pressure and weight were recorded (weight was recorded at 12 months only). It includes the principal University library â the Bodleian Library â which has been a legal deposit library for 400 years; as well as 30 libraries across Oxford including major research libraries and faculty, department and institute libraries. Julian then stands in a skate park while holding a Subway sandwich in one hand. This intervention could be more easily integrated into clinical care by patients and healthcare professionals, and would allow remote monitoring, an important consideration when people are restricted to staying home because of disability or to avoid exposure to infection. Practice staff were notified of patient group allocation by email. Self-reported adherence in both groups was high throughout (Medication Adherence Rating Scale questionnaire27: median baseline 24, maximum possible 25, interquartile range 23-25; at 12 months: 24, interquartile range 23-25 in the control group, and 24, interquartile range 24-25 in the intervention group; P=0.97 for the difference). Princess Beatrice's husband Edoardo Mapelli Mozzi sports a personalized baseball cap as they go food... Susanna Reid, 50, fears being left alone in her 'empty nest' when all three of her sons go off to university. Stream Babert - Boogie Oogie (Original Mix) by L.O.Dee from desktop or your mobile device. *Partial withdrawals withdrew from the intervention but consented to be followed up. Participants allocated to usual care were not provided with self-monitoring equipment or the HOME BP intervention, but had online access to the information provided in a patient leaflet for hypertension (patient.co.uk; through the same system that delivered the online questionnaires). The principal analysis used raw and adjusted data, and was agreed in a statistical analysis plan before final data lock (see appendix). The study compared a digital intervention for hypertension management and self-monitoring of blood pressure with usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner). This reduction meant that by 12 months a significant difference was found (−0.4, 95% confidence interval −0.5 to −0.2) between the usual care and intervention groups (table 5). The film is the sequel to the hugely successful Deadpool, which remains the highest grossing R-rated film ever. Information about possible adverse effects was derived from an extended version of the illness perceptions questionnaire symptoms section and showed no differences between groups29 (table 3). The 18-year-old raps to a â¦ Previous self-monitoring interventions have proven to be cost effective in the long term within standard parameters.1112, Interestingly, the patient enablement instrument showed that patients were enabled to be more active in controlling their hypertension. Unit costs of Health and Social Care. The difference in mean cost per patient was £38 ($51.3, €41.9; 95% confidence interval £27 to £47), which along with the decrease in systolic blood pressure, gave an incremental cost per mm Hg blood pressure reduction of £11 (£6 to £29; table 7). During the trial, we decided to increase the sample size to 610 to allow for a 20% dropout rate because of concerns about higher than expected initial dropout (which later proved unfounded). (Credit: David M. 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