Authors (including presenting author) :
Fu SN (1); Dao TMC (1); Luk W (1); Wong CKH (2); Cheung BMY (3)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Kowloon West Cluster (2) Department of Family Medicine and Primary Care, University of Hong Kong (3) Department of Medicine, University of Hong Kong
Introduction :
International guidelines recommend using home blood pressure monitoring (HBPM) to diagnose hypertension and monitor treatment response. Control of home BP to target level has been shown to reduce hypertension-related complications, such as major cardiovascular events.
Objectives :
To review the factors for successful implementation of HBPM in outpatient clinics, particularly target on older patients with low literacy.
Methodology :
Five electronic databases (MEDLINE, EMBASE, PUBMED, DynaMed Plus and Cochrane Library) were searched using various keywords, including older patients, aged, low educational level, low health literacy and home blood pressure monitoring. Systematic reviews of original studies were included if they assessed factors to implement high quality HBPM in patients with low health literacy. We followed the PRISMA statement on reporting systematic reviews. Quality of the literature was assessed using the Cochrane tool for assessing risk of bias and Newcastle-Ottawa Scale adapted for cross-sectional studies.
Result & Outcome :
There were 3 interventional studies, included 2 randomized controlled trials and one pre/post interventional study. Their quality ranged from moderate to low. Five out of 12 cross-sectional studies rated unsatisfactory quality. Only 2 studies targeted on older patients. None targeted on patients with low literacy. Other studies recruited patients with hypertension from general population. The studies revealed 5 ingredients for high quality HBPM. The first ingredient is selection of patients with uncontrolled hypertension as HBPM priority users. The second ingredient is promotion of patients’ and clinicians’ positive attitude towards HBPM. The third ingredient is provision or assisted choice of validated HBPM devices. The fourth ingredient is step-by-step education of HBPM procedure according to patients’ understanding. The fifth ingredient is enhancement of positive behavior according to HBPM readings, such as better clinician-patients communication, drug compliance and healthier lifestyle modifications. The recommended ingredients should be applied according to patients’ acceptance and capability. Conclusion: Daily practice interventions to improve high quality HBPM among vulnerable population of older patients with low level of literacy is suggested, although the quality of evidence on this topic is limited.
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