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Title: What is the role of self-monitoring blood pressure in the management of hypertension?
Author: Fletcher, Benjamin
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2017
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Patient self-monitoring of blood pressure (SMBP) has shown promise in contributing towards improving ongoing management of hypertension, however it has yet to be fully integrated into guidelines or routine general practice in the UK. The aims of this thesis were to investigate the role of SMBP in the management of hypertension to better understand: patient and clinician attitudes to SMBP; what behaviour change SMBP targets in patients to bring about better BP outcomes; to what extent SMBP is utilised as part of routine hypertension management in the UK; and to understand patient preferences for hypertension management in light of effective models of care. A mixed methods approach was used including: systematic reviews of qualitative and quantitative evidence; semi-structured interviews with patients; a cross sectional survey; and a discrete choice experiment. Self-monitoring was associated with better medication adherence, which could have significant impact at a population level given the high proportion of non-adherent hypertensive patients. Use of SMBP should be seen as a continuum from being used solely to inform clinical decisions, through facilitating interaction between patients and clinicians, to empowering patients to be autonomous for example in self-management. SMBP was most effective when patients had the knowledge and skills to make improvements in their lifestyle, and this has been shown in clinical trials and through qualitative investigation. Clinicians recognise the potential benefits of SMBP, but are concerned that patients may become burdened. Clinicians should feel encouraged that patients are supportive of self-monitoring, but they must ensure that patients who wish to self-manage are equipped with the skills to do so. Lack of facility to make positive change may lead some patients to feeling disempowered and clinicians need to be cognisant of this fact.
Supervisor: Hinton, Lisa ; McManus, Richard ; Rivero-Arias, Oliver Sponsor: National Institute of Health Research (NIHR) School for Primary Care Research (SPCR)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Hypertension ; Self-monitoring