Blood pressure self-measurement in the obstetric waiting room.

BACKGROUND: Pregnant diabetic patients are often required to self-measure their blood pressure in the waiting room before consultation. Currently used blood pressure devices do not guarantee valid measurements when used unsupervised. This could lead to misdiagnosis and treatment error. The aim of this study was to investigate current use of blood pressure self-measurement in the waiting room in order to identify challenges that could influence the resulting data quality. Also, we wanted to investigate the potential for addressing these challenges with e-health and telemedicine technology. SUBJECTS AND METHODS: We observed 81 pregnant diabetics' ability to correctly self-measure in the waiting room during a 4-week observational descriptive study. Specifically, we investigated the level of patient adherence to six recommendations with which patients are instructed to comply in order to obtain a reliable blood pressure reading. RESULTS: We found that the patients did not adhere to given instructions when performing blood pressure self-measurement in the waiting room. None of the 81 patients adhered to all six investigated recommendations, while around a quarter adhered to five out of six of the recommendations. The majority followed four or fewer of the recommendations. CONCLUSIONS: Results indicate that unsupervised self-measurement of blood pressure is not a reliable method. Thus, there is a need for increased staff presence and patient training or, alternatively, for introducing improved technology support. This could include context-aware patient adherence aids and clinical decision support systems for automatically validating self-measured data based on e-health and telemedicine technology.

Measurement adherence in the blood pressure self-measurement room.

BACKGROUND: Patients with hypertension or receiving blood pressure (BP)-lowering treatment are often required to self-measure their BP in a dedicated self-measurement room before consultation. Current praxis does not guarantee valid measurements, possibly leading to misdiagnoses or inappropriate antihypertensive medication. The aim of this study was to investigate patients' ability to correctly self-report and follow recommendations. PATIENTS AND METHODS: We used a context-aware system to gather information on BP measurements and relevant context parameters. Patients were not informed that the system automatically collected behavior data and were instructed to self-report their measurements on a paper sheet as usual. We then compared the automatically recorded data with the self-reported data in order to detect any nonadherent reporting behavior. Also, we investigated the patients' ability to adhere to the measurement recommendations. RESULTS: We found that (1) a third of all 113 participating patients failed to self-report measured BP data correctly and (2) none of the 642 measurements obtained adhered fully to the recommendations. CONCLUSIONS: Results indicate that context-aware technology may be useful for accurately modeling aspects of nonadherent patient behavior. This may be used to inform staff of the validity of the measurement and pinpoint patients in need of additional training or to design better aids to assist the patients. The developed system is generally applicable to other self-measurement environments, including the home setting and remote outpatient clinics, as it is built using telemedicine technology and thus well suited for remote monitoring and diagnosis.

Challenges in blood pressure self-measurement.

Blood pressure self-measurement (BPSM) requires patients to follow a range of recommendations in order to be considered reliable for diagnostic use. We investigated currently used BPSM interventions at four medical clinics combined with an online questionnaire targeting BPSM users. We found that the participating healthcare personnel perceived BPSM as a relevant and useful intervention method providing that the recommendations are followed. A total of six challenges were identified: (1) existing devices do not guarantee that the recommendations are followed, (2) healthcare providers cannot verify whether self-monitoring patients follow the recommendations, (3) patients are not aware of all recommendations and the need to follow them, (4) risk of patient induced reporting bias, (5) risk of healthcare provider induced data-transfer bias, and (6) risk of data being registered as belonging to the wrong patient. We conclude that existing BPSM interventions could be significantly affected by user-induced bias resulting in an indeterminable quality of the measurement data. Therefore, we suggest applying context-aware technological support tools to better detect and quantify user errors. This may allow us to develop solutions that could overcome or compensate for such errors in the future.