Nathan Riddell and Osian Smith
Aneurin Bevan University Health Board, in partnership with Swansea University
Background:
500,000 people in Wales have a diagnosis of high blood pressure (hypertension) and research from British Heart Foundation Cymru suggests another 350,000 have undiagnosed hypertension. GPs are responsible for diagnosing, monitoring and treating hypertension; a disease which significantly increases the risk of stroke and heart attack.
Six-monthly or annual check-ups offer only a tiny snapshot of a patient’s true blood pressure and may be inaccurate based on factors such as the white coat effect, exercise or stress resulting in wrong diagnoses of hypertension, inadequate (or over-zealous) treatment and associated side effects.
Hypertension is a silent killer with patients experiencing minimal symptoms until strokes or heart attacks occur, which reduces patient compliance with treatment.
Aims:
The aim of this project is to develop a smartphone application that allows patients to take their own blood pressure readings at home and produce an average reading over 7 days, which is compliant with National Institute for Health and Care guidance for home blood pressure monitoring. It also produces more accurate readings that GPs can use.
The team’s initial aim was to send this blood pressure reading directly to the GP record. However, further product research meant that they revised this aim.
The project embodies prudent healthcare principles by encouraging collaboration between patients and GPs; using existing resources (blood pressure monitoring appointments with GPs) and equipment (smartphones) to best effect; applying evidence-based principles in technology-enabled monitoring to improve accuracy; and (through discussion with GPs, patients and healthcare professionals) providing a local app both meets current needs and fits resource requirements.
Challenges:
Initial work with GPs and a telemonitoring researcher uncovered a concerning issue with the core aim of sending readings into the GP record remotely. The issue was that there was a lack of governance over who would take responsibility for those readings, and where would they be hosted.
Instead, through extensive discussion, we found that a local-only app which records readings and provides the patient with a completed PDF form of their readings at the end of the monitoring period would be sufficient and would still meet the core aims of the project. This form could then still be shown to their GP during an appointment.
Over the project period, the team had some difficulty accessing available funding due to the structure of the project being independent of NHS bodies. Given these issues, the development was completed solely by the project team without external professional software development support. This, in combination with both project team members being in full-time positions outside the project, created a challenge in terms of time commitment and delayed the project timeline – eventually finishing the final release in December 2018.
Outcomes:
This app aims to engage patients in their own health management by giving them the power to contribute to their own wellbeing. It introduces visual feedback and a collaborative element to the interactions between GPs and patients.
The team envisages this will also create a more motivated patient who can take control in other areas of life – to override the apparent absence of physical symptoms in hypertension.
The introduction of robust averages over a week rather than at single point of testing will also provide GPs with more accurate information to make informed decisions. GPs can then work collaboratively with patients to control their blood pressure and ensures this remains at healthy levels (i.e. reduce over- or under- treatment and the associated side effects).
Next steps:
Having created a viable application which addresses the core aims of the project, the next step is to trial this with a small group of patients across 1-2 GP surgeries to gain feedback on the app itself and its implementation on a wider scale.
The team has also begun the process of creating an online portal so that patients to see their own results, and they plan to trial this with GPs once appropriate security compliance is secured.
The team also aims to produce a similar application for the monitoring of blood sugar in diabetes and peak flow diurnal variation in asthmatics to provide better information to GPs and improve communications between GPs and patients who have chronic conditions. Using a smartphone application to check blood pressure at home
“The Bevan Exemplar programme was a brilliant foray into medical innovation and a true experience of the nuances of NHS finance, management and administration.”
Nathan Riddell
