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Liverpool Health Trainers and home blood pressure monitoring

posted 25 May 2017, 06:00 by Hollie O'Connell   [ updated 30 May 2017, 08:40 ]


Sharon Poll 
Liverpool CCG - GPN Lead 


30 May 2017  


Hypertension case studies 



Liverpool Health Trainers is managed by Person Shaped Support, they help to empower and enable referred patients to manage their health better through education and support.  They have been using Florence to help monitor blood pressure and have shared some of their case studies. 


CASE STUDY 1
Patient X was referred to their Health Trainer via their GP practice.  The patient had been experiencing strain from their overall health issues combined with a high blood pressure reading which may have been making the patient feel worse. 

The patient’s GP identified an opportunity for the patient to be introduced to Flo to facilitate the collection of short term home blood pressure readings.  The patient’s GP was keen to understand if there was any change in the patient’s blood pressure at home from that recorded at the surgery to inform a diagnosis or exclusion of hypertension, and to ensure the most appropriate treatment plan was arranged for the patient. 

The Health Trainer provided the patient with a hypertension diagnosis shared management plan, and explained to them how Flo would prompt them to send in their blood pressure and also offer advice dependent upon the patient’s reported readings as agreed with their GP.  These readings would then be reviewed at the surgery to inform on-going treatment. 

The patient left their appointment with their Health Trainer reassured and enrolled onto Flo, awaiting their first request for their blood pressure reading. 

Upon further review of the patient’s blood pressure readings, their average blood pressure was within the normal range compared to readings taken solely at the practice, and a diagnosis of hypertension was excluded by the GP. 

The Health Trainer commented that having the time to discuss Flo and how she can support the patient’s on-going treatment plan was useful.  The patient reported that on the day he had his blood pressure taken in surgery, his shirt had been tight and he was anxious which may have impacted on a false high reading.  Using Flo provided the patient with reassurance that their real time home blood pressure readings could be reviewed to provide data for an accurate diagnosis without the impact of external influences brought about by attending the surgery. 

The Health Trainer commented;

" Florence totally sorted this out as the patient was more relaxed and not rushed doing it at home. The patient now feels far more reassured. "



CASE STUDY 2
Patient X with uncontrolled hypertension was referred to their Health Trainer by their GP to use Flo.  The aim was to support the patient in improving compliance with their hypertensive medication and for education and motivation to adopt a healthier lifestyle in support of gaining better control of their blood pressure. 

On meeting the patient, the Health Trainer discussed Flo and how she can support the patient’s on-going treatment plan.  The patient was quickly enrolled onto an 8 week programme with Flo supported by a shared management plan and guidance on how to take home blood pressure readings. 

The Health Visitor offered to create a Personal Health Plan for the patient, however the patient was keen to follow Flo’s programme and to make the necessary lifestyle changes. 

Over the 8 weeks since being introduced to Flo, the patient’s blood pressure control has significantly improved 
  • Week 1 - average BP 163/122 
  • Week 8 - average BP 142/98 

The patient was thankful for Flo’s additional support and commented that Flo was " a real help to him and kept him on track " and explained to his Health Trainer how he could see the improvements in his blood pressure and the difference it was making for him. 

Importantly, the patient is now also more aware of the importance of taking his medication as prescribed and aims to continue to make further lifestyle improvements.



CASE STUDY 3
Patient X was referred to her Health Trainer by her practice nurse. The patient’s blood pressure was remaining high regardless of prescribed medication aimed to control it.  The nurse had identified using Flo as a tool to compliment the care already being given, helping to motivate and educate the patient to adopt a healthier lifestyle in support of gaining better blood pressure control. 

Flo was discussed with the patient and the Health Trainer explained what the patient could expect over the next week of home blood pressure monitoring.  A demonstration of how to use the blood pressure monitor was provided and a shared management plan was agreed with the patient. 

The Health Trainer explained the risks associated with high blood pressure and provided brief information regarding how lifestyle improvements can help to control and reduce high blood pressure. 

The patient visited her GP a few days later and through a discussion around her blood pressure realised she should have been taking three tablets rather than two.  The patient’s GP advised her to increase her medication to the prescribed dosage, and to continue to report her blood pressure to Flo for a further two weeks.  With the patients improved medication adherence, the GP could review the impact of the new dosage.

On review and after increasing her medication to the prescribed dose the patient’s average week reading was 151/98 mmHg.  The patient continued to take her blood pressure at home and send them to Flo for a further two weeks.

In the meantime the Health Trainer sent the patient’s blood pressure readings that had been reported to Flo to her GP.  Having reviewed the readings, the patient’s GP called her to ask that she return to the surgery to discuss her medication.

Based on the patient’s reported home blood pressure readings via Flo, the GP was able to intervene earlier upon identifying that the patient’s blood pressure medication needed to be increased; the GP subsequently requested that the patient continue to send Flo her home readings for a further week.

At the patient’s last review, the benefits of leading a healthy lifestyle were recapped, and information on the Health Trainer service was provided for any help or support to make lifestyle changes.  The patient’s average blood pressure at the end of the home monitoring via Flo had fallen to 118/84 mmHg and the GP was now confident that her antihypertensive medication had been titrated accurately.