Primary care doctors’ views on self-monitoring of blood pressure and self-titration among patients with uncontrolled hypertension in Spain. The Adampa trial focus group study.

Abstract

Background: Despite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The Adampa study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension. Aim: To explore the views and attitudes of primary care doctors participating in the Adampa trial regarding BPSM with self-titration. Design & setting: A focus group study took place with primary care doctors participating in the Adampa trial, which was carried out in one health district of the Valencia Health System in Spain. Method: Nine primary care doctors participating in the Adampa trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics. Results: Participating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control. Conclusion: Primary care doctors participating in the Adampa trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.