Compliance is a major issue in any chronic disease management, combined with the high prevalence of diabetes across Sandwell and West Birmingham, compliance to treatment is a particular challenge to patients achieving their optimum disease control and preventing or delaying further deterioration to their health.
Through his clinical practice, Dr Parijat De recognised the impact that poor compliance to self-management and treatment was having on his patients’ disease control. Given the compliance issues faced, together with poor blood pressure control among high risk patients with diabetes and renal disease, Dr De accepted the challenge to address this in order to improve the clinical outcomes and quality of life for his patients.
Consequently, Dr De harnessed Flo as a tool to integrate into his treatment planning, aimed at specifically improving his patients’ adherence to their blood pressure treatment.
Flo’s interactions were designed to gently educate and motivate patients to become more engaged and confident to self-manage their blood pressure outside of face to face care, with regular encouragement to follow their treatment plan.
Some sphygmomanometers were made available to lend to hypertensive patients, however most patients purchased their own blood pressure machines after the team explained how Flo’s support could help them.
Dr De has shared three patient stories.
Patient One
A 72 year old lady with type 1 diabetes, hypertension and a background history of Conn’s syndrome (diagnosed in 2008) was referred to me for her uncontrolled blood pressure and resulting symptoms. Given her resistant hypertension and an endocrine cause for her high blood pressure, this patient’s blood pressure needed to be monitored very carefully.
The patient was already taking Amlodipine 5mg, Indapamide SR 2.5mg and Losartan 100mg daily, was not able to tolerate Doxazosin and empirically was treated medically for her Conn’s syndrome with Spironolactone.
The patient had demonstrated that she needed to be reminded initially to check her own blood pressure readings on a regular basis, and needed both hospital and primary care monitoring for this which she found very difficult to cope with given all her complex endocrinology investigations that were being carried out simultaneously alongside.
So we introduced Flo to the patient specifically to support her blood pressure management.
With Flo’s interactions, the patient’s blood pressure ranged between 140-150/60-80. Given that the patient had successfully stabilised her blood pressure during monitoring with Flo’s regular two-way dialogue, she was then able to reduce Flo’s interactions to once or twice a week.
The patient was quite happy with the feedback received from Flo on a regular basis and she explained that this helped her to feel more confident. This model of care proved to be more convenient for the patient as she did not have to travel to hospital or her GP surgery clinics for this regular blood pressure monitoring.
Given her complex endocrinological condition and resistant hypertension, the patient continues with active Flo support on an ongoing basis and is currently very pleased.
“I found using Flo very good as a reminder and a discipline for remote monitoring of my BP. Obviously more convenient than travelling to the GP or hospital”
Patient Two
A renal patient with associated diabetes and resistant hypertension is under my care having been treated with four different blood pressure medications previously.
Acknowledging the co-morbidities experienced by the patient, we recruited Flo to support the patient specifically around improving the frequency of their home blood pressure monitoring, and the confidence to act on the advice agreed in their shared management plan.
Flo began to prompt the patient to take their blood pressure and send the reading back to her, where Flo would give appropriate advice, the patient was also reminded to take their medication as prescribed.
With these friendly prompts and guidance the patient sent regular readings in and enabled the team to accurately titrate their medication. With the patient taking their medication more accurately, the team were able to more closely monitor the resulting impact on their blood pressure.
As a result, the patient’s blood pressure control improved significantly in this very high cardiovascular risk patient.
“I have found using Flo really good, the reminder and what to do with blood pressure is too high is very useful as there are times when you forget that it is time to check the blood pressure and you get a gentle reminder. Doing the BP at home is less stressful as it is a more relaxed environment“
Patient Three
I have been treating a 72 year old gentleman with type 2 diabetes, anaemia, hypertension, depression, hypercholesterolemia and previous history of drug induced hyponatraemia.
The patient’s blood pressure had been fluctuating with low sodium levels since May 2017, and a number of his blood pressure medications had to be stopped including Lisinopril prescribed for his for low sodium levels.
The patient had undergone twenty-four hour ambulatory blood pressure readings which confirmed a persistent high blood pressure and as a consequence, Lisinopril was reintroduced along with Indapamide and Amlodipine 5mg once a day; Doxazosin was also added which we later discovered the patient could not tolerate.
At this point we felt that Flo could offer support to the patient in managing his blood pressure and becoming more complaint with his treatment plan. We discussed this and the patient was happy to receive Flo’s support via his son, who was active in his father’s care, sending his father’s readings.
We also felt that recruiting Flo to gently remind the patient of the lifestyle changes that we had previously discussed with him, would continue the conversation beyond his hospital appointment and motivate him to take the required actions.
With friendly prompts reminding the patient to take his blood pressure readings and the motivation to act on the advice, Flo helped the patient ensure that his systolic blood pressure became more stable, ranging between 125-145 and diastolic 80-92 mm mercury.
As you can see, the patient had multiple medical co-morbidities. The patient’s blood pressure control was not being helped by them feeling very weak, lethargic and quite depressed resulting in the patient’s blood pressure remaining high and volatile.
Now with Flo’s help, the patient’s blood pressure is stable and he is sending blood pressure readings via Flo once a week.
The patient’s son, who regularly keeps an eye on his father’s blood pressure and also sends his reading to Flo commented:
“Florence has been definitely beneficial to my father and it is very helpful to take blood pressure readings at home in a familiar and relaxed environment especially as his blood pressure is always high when he visits the hospital or GP.
It also avoids lots of further journeys which means he can use this time saved in a different way. More importantly he has peace of mind that his blood pressure is being monitored and that he would be notified if there was an issue that needed action. Although he is quite disciplined in the way we keep an eye on his blood pressure, Florence reminders are also very useful in following exercise and diet. I would definitely recommend this service“
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