SHIP Qualitative study

• Research type

  Research Study

• Full title

  Studying HypertensIon Plus: A qualitative study of Hypertension-Plus, a hypertension self-monitoring / self-management service in primary care

• IRAS ID

  297000

• Contact name

  Rebecca Barnes

• Contact email

  rebecca.barnes@phc.ox.ac.uk

• Sponsor organisation

  University of Oxford

• Duration of Study in the UK

  1 years, 3 months, 31 days

• Research summary

  Research Summary
  Overview
  Hypertension-Plus (HTN+) is a telemonitoring and decision support system developed by Omron PLC, a blood pressure monitor manufacturer, building on previous work undertaken by the CI. The system allows health care professionals (HCPs) and patients to share information about home blood pressure levels and treatment recommendations. It provides reminders for monitoring and alerts for action to both patients and professionals. The study will investigate the implementation of the HTN+ system in UK primary care with the aim answering the following research question: ‘What are the challenges to successful implementation and sustainability of the HTN+ blood pressure self-management intervention in routine clinical practice and in patients’ homes?’

  Background
  The best way to reduce the health risks associated with hypertension is to reduce high blood pressure, and yet at present perhaps one third of people with hypertension do not have their high blood pressure properly controlled. This research will explore how well a new system (intervention) assists HCPs and people with high blood pressure (hypertension) withmanaging their condition. The intervention targets people with hypertension measuring their blood pressure at home, with input from a HCP or specialist when needed.

  Methods
  We will study How and Why the implementation of HTN+ succeeds and/or fails in at least six GP surgeries over one year. We will investiate factors that predict or influence adoption, implementation (including barriers and facilitators), sustainability, reach and effectiveness (or otherwise) of the system, and how these factors vary across different contexts. This will be achieved by collecting and analysing data including:
  - interviews with implementation leads; individuals from Clinical Commissioning Groups, Primary Care Networks and GP surgeries; HCPs; and eligible patients who are using or not using the system;
  - patient audio diary entries;
  - qualitative observations from GP surgery contacts with patients;
  - customer service data from Omron;
  - findings about take up and blood pressure control from a parallel service evaluation.
  The research team will consult with members of the public and take their opinions into consideration at all stages of the study.

  Results
  Omron, NAPC and EY; commissioners of care in stdy areas; study practices; patients involved in the study will be provided with summaries of the results. Also, the research findings will be published in journals , presented at conferences and disseminated through social media.

  Summary of Results
  Studying Hypertension Plus (SHIP): A qualitative study of Hypertension-Plus, a hypertension self-monitoring / self-management service in primary care

  High blood pressure, or hypertension, is a major risk factor for disability and death worldwide. The best way to reduce the health risks associated with hypertension is to reduce high blood pressure (BP), and yet at present perhaps one third of people with hypertension do not have their BP properly controlled. In clinical trials, supported BP self-monitoring by patients at home and linked co-interventions have been shown to reduce high BP, however, evidence from real-world implementation is limited. We explored what happened when general practices invited their patients with hypertension to try a novel system called Hypertension-Plus (HTN+), measuring their blood pressure using an 'App' at home, with input from a health care professional (HCP) or specialist when needed.
  HTN+ is a telemonitoring and decision support system developed by Omron PLC, a blood pressure monitor manufacturer, building on previous evidence from clinical studies undertaken by the wider SHIP study team. The system allows HCPs and patients to share information about home blood pressure levels and treatment recommendations. It provides reminders for monitoring and alerts for action to both patients and professionals. Our research explored how well this new system assisted HCPs and people with hypertension with managing their condition. We asked the following research question: 'What are the challenges to successful implementation and sustainability of the HTN+ BP self-management intervention in routine clinical practice and in patients' homes?'

  Between October 2021 and October 2023, our researchers recruited and interviewed 46 individuals about their experiences of the intervention: (i) 20 patients enrolled in six general practices in England who had been invited to use HTN+, including those who declined, discontinued, or sustained its use; (ii) 13 general practice staff involved in implementation on the ground (GPs, clinical pharmacists, nurses, practice managers, social prescribers); and (iii) 13 other stakeholders involved in leading or supporting the roll out of HTN+. We recorded and transcribed the interviews and looked for commonalities and differences across the data. A parallel study of the effectiveness of HTN+ by our wider team found its use was associated with significant reductions in BP in those offered the intervention in GP practices compared to those receiving usual care. To read more about this part of the study please see here.
  Our study found usual hypertension care was described as fragmented, whereas patients found the HTN+ intervention user-friendly, useful for managing blood pressure, and appreciated greater practice engagement. Staff valued the intervention's efficiency gains in patient management but noted challenges with onboarding, IT integration, workflow and whole-team engagement. There were also equity concerns related to digital literacy, language, and access barriers, particularly affecting traditionally underserved patient groups. COVID-19 and NHS restructuring both hindered and accelerated adoption, although iterative refinements by the manufacturer demonstrated the intervention's adaptability. Future potential may lie in expanding the platform to support multiple long-term conditions and integrated care.
  This intervention was a testbed for implementing an industry-developed digital tool in primary care. It showed promise for engagement and structured hypertension management, but uptake was limited by challenges including equity concerns, organisational workflows and wider complexity. Sustainable scale-up requires smoother IT systems integration, clear staff roles, and demonstrable value and access. Hypertension was seen as only one potential area for intervention with clinicians and patients highlighting the need for a multi-condition or "digital front door" platform.
  This research was carried out by a team of researchers at the Universities of Oxford and Edinburgh. The study was funded by the National Institute for Health and Care Research via Oxford and Thames Valley Applied Research Collaboration (ARC). The study sponsor was the University of Oxford. Public and patient involvement members of the multiple long-term conditions cross-ARC collaboration group provided advice and support throughout the study. A patient representative also attended our study meetings and gave feedback on our work. The study team would like to thank all the public and patient representatives and all of our research participants for their valuable input.
  

• REC name

  Wales REC 4

• REC reference

  21/WA/0280

• Date of REC Opinion

  10 Aug 2021

• REC opinion

  Favourable Opinion