Ulrika Andersson´s research

E-health in the treatment of hypertension in primary care

Hypertension is the most common chronic diagnosis in Swedish primary care, affecting one fourth of the adult population. The majority of patients don’t reach target blood pressure, despite treatment. Technology and a person-centered perspective is a way to improve this.

Despite the availability of effective treatment strategies, hypertension is still a major health problem. With an increasing elderly population and limited health care resources, new, more effective, ways of treating chronic conditions, such as hypertension, is required. Acknowledging the patients´ capabilities, together with technology, could pave the way for a better treatment. During a pilot project, an interactive web based system to support self-management of hypertension was developed and evaluated. The results where promising, with significantly decreasing BP as well as increased understanding of the condition and motivation to the treatment for the patients.

The overall aim of this thesis is to evaluate if the treatment of hypertension can improve through the support of self-management of the condition by the use of an interactive web based system.

The material comes from the project PERHIT, a randomized controlled clinical trial performed in four regions in primary care settings, including 900 patients, for twelve months. The patients in the intervention group receives a home BP monitor and will use the support system for eight weeks. They self-report, once daily, via their own mobile phone; BP, pulse and rates their wellbeing, physical activities, symptoms and side effects during the day. They can receive graphical feedback through a secure web portal and are offered to receive motivational messages throughout the study period. A follow-up consultation with a nurse or physician is conducted after eight weeks and twelve months.

Study 1 is a cross-sectional study on baseline data aimed at identifying groups of patients with special needs for support to reach treatment goals.

Study 2 is a qualitative study where focus group interviews are held with patients and health care professionals.

Study 3 will evaluate the effect of using the system in reducing blood pressure, measured as office BP at baseline, by eight weeks and after twelve months.

Study 4 will explore the relationships between patients’ self-monitoring of BP and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms.

If more patients with hypertension can reach target blood pressure, the risk for cardiovascular events will decrease. This will lead to less suffering for the patients and a cost reduction for the society.

Center for Primary Health Care Research, Department of clinical sciences Malmö, Lund University

Supervisor: Patrik Midlöv