One emerging trend in health care is more care at home and often that care is delivered in whole or in part by the patient him or herself. Research reported in the Journal of the American Medical Association explores how well patients with high blood pressure do at self-monitoring and self-titration of medications to treat their condition. (JAMA Article) The research was conducted in England among a set of patients with hypertension and a risk of a cardiovascular event. This was a randomized trial with a control group of usual care. The intervention group received training to self-monitor blood pressure with a standard device and to adjust their doses of medication depending on the results of the monitoring. They were instructed to contact their physicians if there were either very high or very low blood pressure readings and the doctor could decide to change the medicine or dose. The primary outcome was systolic blood pressure after 12 months of participation in the intervention group. There were about 225 patients in each arm of the trial, but a large number of patients declined to participate in the trial because they did not want to be responsible for measuring their own blood pressure and/or adjusting medication, suggesting that there may be limitations to how far into the patient population self-care can reach. The self-care group in this trial achieved blood-pressure lowering equal to or superior to the usual care group. The self-care group did have greater use of medications, both number and dose, but there was no difference in rates of adverse reactions to the drugs. The trial suggests that self-care for chronic conditions is possible and can result in good outcomes. Self-care is certainly one of the highest forms of patient engagement. But the people most likely to be engaged in their health anyway probably were most likely to participate in this trial and other self-care efforts, and the high rates of people who didn’t want to participate suggests that methods need to be found to encourage more patients to do self-care.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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