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The Australian Broadcasting Corporation's 7.30 Report needs to follow up on it’s 2000 predictions.
- Phillip J. Colquitt (18 October 2004)
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Self monitoring of blood pressure at home
- Malcolm Aylett (22 October 2004)
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Informed self-regulation of medicines: the next step?
- Caroline L Kelham (28 October 2004)
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Phillip J. Colquitt, Technician/RN Independent Comment
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Regardless of the preferred setting used to take the blood pressure, the credence given here to home monitoring[1] presupposes suitable and safe blood pressure measuring devices purchased by a well informed consumer. A mercury sphygmomanometer is not safe[2], due to it’s now century old design faults, yet it is the preferred instrument of doctors. Here in the metropolitan area of Brisbane, this very day, consumers can buy mercury based sphygmomanometers from sellers of first aid equipment in the walkways of major shopping centres. It's as if the seller is aping the doctor. Mercury droplet leakage from these unsealed, unlabelled containers of poison(mercury sphygmomanometers), will inevitably cause health problems and contamination in otherwise happy domestic environments, where non-mercury devices should have been purchased. It will also have the effect to devaluing the properties where Hg is spilled. This is the mercury that we were led to believe was being abated, due to environmental concerns, in the Australian Broadcasting Corporation’s prime time TV current affairs segment “7.30 Report”, shown on national Australian TV in February 2000[3]. Four years later, and we see little evidence of the abatement. [1] George Stergiou, Thomas Mengden, Paul L Padfield, Gianfranco Parati, Eoin O'Brien, working group on blood pressure monitoring of the European Society of Hypertension. Self monitoring of blood pressure at home.BMJ 2004; 329: 870-871. [2] A C Rennie, M McGregor-Schuerman, I M Dale, C Robinson, and R McWilliam. Lesson of the week: Mercury poisoning after spillage at home from a sphygmomanometer on loan from hospital. BMJ, Aug 1999; 319: 366 - 367. [3]European countries ban sphygmomanometer[Transcript]. ABC 7.30 Report. 15/2/2000. Accessed 18 Oct. 2004 at: http://www.abc.net.au/7.30/stories/s100543.htm Competing interests: None declared |
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Malcolm Aylett, Retired general practitioner 13 Williamstowe, Coombe Down, Bath, BA2 5EJ
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The review of home BP monitoring sets out recommendations which are similar to those published some years ago as a result of reviewing the literature and a study confirming the feasibilty and acceptability of the procedure. The problem of course is not deciding what should be done but in getting recommendations implemented. Primary Care, where most British hypertensive patients are exclusively managed, remains sceptical about this procedure despite the use of semiautomatic devices now being commonplace. Now, in my dotage, I am on the receiving end of the sphygmomanometer and I sadly find that my carers are only interested in isolated office readings. Competing interests: None declared |
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Caroline L Kelham, Project Manager Medicines Partnership SE1 7JN
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Whilst highlighting that home blood pressure readings can be lower and more reliable than those taken in the clinic, the authors seem reluctant to recommend extensive use of the practice or take the next step of empowering patients to take action based on these results. However we already know that patients adjust their medicines, or even stop taking them altogether without consulting a doctor or looking at their latest blood pressure readings. An estimated 50% of medicines for long term conditions are not taken as prescribed and research shows that patients’ beliefs about medicines are the biggest predictor of compliance, with beliefs about the necessity of the medicine weighed against concerns about side effects and dependency [1]. People are therefore more likely to benefit from therapy when they balance these beliefs in a more informed way, through better understanding of the diagnosis and treatment and being actively involved in decisions about the management of the condition. So for some patients, a combination of home monitoring of blood pressure and self-adjustment of medication with professional support could be a more effective way of finding their optimum level of control than just being instructed to ‘follow doctor’s orders’. Despite this, research to date has focussed on self-monitoring with comparatively few studies investigating the potential for informed self- regulation of medicines. However, small-scale studies on self-monitoring and self-medication in hypertension [2] and anticoagulation management [3] already give positive signs that this is an avenue to pursue. Patients successfully completed training in monitoring and medication-adjustment techniques and carried them out in a home setting without complication. They valued the method and some improvement in control was reported. A recent Cochrane review also reported better lung function outcomes in those who adjusted their medication using a written plan than in those whose medication was adjusted by a doctor [4]. Medicines Partnership are currently developing a pilot with Hillingdon Hospital and Hillingdon PCT to test the approach in a UK setting involving patients with diabetes who have high blood pressure. We feel it may be particularly suitable to patients with diabetes who are already accustomed to self-management and adjustment of insulin or oral medication on the basis of self-testing. We recognise that this approach will not be for everybody and that it is important not to impose a regime that will add to somebody’s anxiety. However, we feel self-regulation on the basis of home monitoring could be an effective option in an area where control is critical but current methods are not always effective. More information about this and other Medicines Partnership projects are available at http://www.medicines-partnership.org/projects/current- projects. You can contact us at info@medicines-partnership.org. References: [1] Horne R & Weinman J (1999) Patients’ beliefs about prescribed medicines & their role in adherence to treatment in chronic illness. Journal of Psychosomatic Research 47(6): 555-567 [2] Zarnke KB, Feagan BG, Mahon JL, Feldman RD. A randomized study comparing a patient-directed hypertension management strategy with usual office-based care. Am J Hypertens. 1997 Jan;10(1):58-67. [3] Murray E, Fitzmaurice D, McCahon D, Fuller C, Sandhur H. Training for patients in a randomised controlled trial of self management of warfarin treatment. BMJ. 2004 Feb 21;328(7437):437-8. [4] Gibson PG, Powell H, Coughlan J et al. Self-management education and regular practitioner review for adults with asthma. Cochrane database Syst Rev 2003; (1): CD001117. Competing interests: None declared |
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