Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College London, London, United Kindgom.
NIHR ARC North West London, London, United Kingdom.
PLoS One. 2024 Feb 29;19(2):e0298898. doi: 10.1371/journal.pone.0298898. eCollection 2024.
The COVID-19 pandemic led to the implementation of a national policy of shielding to safeguard clinically vulnerable patients. To ensure consistent care for high-risk patients with hypertension, NHS England introduced the BP@home initiative to enable patients to self-monitor their blood pressure by providing them with blood pressure monitors. This study aimed to identify barriers and facilitators to the implementation of the initiative based on the experience and perspectives of programme managers and healthcare professionals (HCPs) involved in its implementation in London.
We conducted five semi-structured focus groups and one individual interview with a total of 20 healthcare professionals involved at different levels and stages in the BP@home initiative across four of the five London Integrated Care Systems (ICSs). All focus groups and interviews were audio-recorded, transcribed and analysed thematically following the Framework Method. Respondents reported being challenged by the lack of adequate IT, human and financial resources to support the substantial additional workload associated with the programme. These issues resulted in and reinforced the differential engagement capacities of PCNs, practices and patients, thus raising equity concerns among respondents. However respondents also identified several facilitators, including the integration of the eligibility criteria into the electronic health record (EHR), especially when combined with the adoption of practice-specific, pragmatic and opportunistic approaches to the onboarding of patients. Respondents also recommended the provision of blood pressure monitors (BPMs) on prescription, additional funding and training based on needs assessment, the incorporation of BP@home into daily practice and simplification of IT tools, and finally the adoption of a person-centred care approach. Contextualised using the second iteration of the Consolidated Framework for Implementation Research (CFIR), these findings support key evidence-based recommendations to help streamline the implementation of the BP@home initiative in London's primary care setting.
Programs such as BP@Home are likely to become more common in primary care. To successfully support HCPs' aim to care for their hypertensive patients, their implementation must be accompanied by additional financial, human and training resources, as well as supported task-shifting for capacity building. Future studies should explore the perspectives of HCPs based in other parts of the UK as well as patients' experiences with remote monitoring of blood pressure.
COVID-19 大流行导致实施了国家保护政策，以保护临床脆弱的患者。为确保为高血压高危患者提供一致的护理，NHS 英格兰推出了 BP@home 计划，通过为患者提供血压监测仪，使他们能够自我监测血压。本研究旨在根据参与伦敦该计划实施的项目管理人员和医疗保健专业人员（HCP）的经验和观点，确定该计划实施的障碍和促进因素。
我们对来自伦敦五个综合保健系统（ICS）中四个 ICS 的不同级别和阶段参与 BP@home 计划的共 20 名医疗保健专业人员进行了五次半结构化焦点小组和一次个人访谈。所有焦点小组和访谈都进行了录音，并根据框架方法进行了主题分析。受访者报告说，由于缺乏足够的 IT、人力和财务资源来支持与该计划相关的大量额外工作量，他们面临着挑战。这些问题导致并加强了 PCN、实践和患者的不同参与能力，从而引起了受访者的公平性问题。然而，受访者还确定了一些促进因素，包括将资格标准纳入电子健康记录（EHR），特别是与采用针对特定实践的务实和机会主义方法相结合时，可提高患者的参与度。受访者还建议根据需要评估提供处方血压监测仪（BPM）、额外资金和培训，将 BP@home 纳入日常实践、简化 IT 工具，并最终采用以患者为中心的护理方法。利用实施研究综合框架（CFIR）的第二迭代对这些发现进行了背景化处理，这些发现支持了关键的循证建议，有助于简化伦敦初级保健环境中 BP@home 计划的实施。
像 BP@Home 这样的计划在初级保健中可能会越来越普遍。为了成功支持 HCP 照顾高血压患者的目标，他们的实施必须伴随着额外的财务、人力和培训资源，以及为能力建设进行支持性的任务转移。未来的研究应探讨英国其他地区 HCP 以及患者对远程血压监测的体验的观点。
