Screening for high blood pressure using self-monitoring (self-screening)

Aims:

Traditionally, blood pressure checks have been done in appointments with healthcare professionals.  Many GP surgeries, pharmacies, and other public places now have blood pressure monitors that can be used by anyone to check their blood pressure. We want to find out if providing facilities where people can check their own blood pressure improves the detection of high blood pressure (hypertension).

Why this is important:

Hypertension (high blood pressure) rarely makes people feel ill. It does, however, increase the risk of having a stroke, heart attack and other serious conditions. Once diagnosed, it can be treated with medication or lifestyle changes – such as diet and exercise - to lower blood pressure and reduce the risk of serious complications.

Some people don't know they have high blood pressure, a programme of self-screening could help to identify these people.
- Professor Richard McManus

As there are no symptoms, it is important for people to have their blood pressure measured. UK surveys have found that there are a lot of people with high blood pressure that are unaware they have the condition and so aren’t receiving treatment. At the moment, most blood pressure checks are done in healthcare appointments at the GP surgery, but not everyone goes there very often. We think that providing screening stations - where people check their own blood pressure (“self-screening”) - could help to pick up more cases and enable more people with high blood pressure to receive the care they need.

Methods:

This project is split up into three smaller projects:

1. Systematic review of self-screening for high blood pressure

There is very little current research on self-screening for high blood pressure. We therefore also included blood pressure screening carried out in the community by people who aren’t doctors. We wanted to find out how successful this type of screening is, and whether anything made it more or less successful.

We carried out a systematic review, which is a detailed look at all the published research on this topic. We found that self-screening works as well as other types of screening.  This is useful because self-screening is probably cheaper than paying someone – such as a nurse - to screen people.

We didn’t find much information on what happened to people after they were screened. This is disappointing, as screening is only useful if people with high blood pressure actually get some treatment. Our pilot study will be trying to fill this gap in the research.

2. Survey and interviews to find out how self-screening is used now, and how it could be used in the future

We did a survey to find out where people can have their blood pressure checked in Oxfordshire.  We couldn’t find any evidence of screening stations in community locations - such as hairdressers, churches and fire stations – all sites which came up in the systematic review.  Almost a quarter of GP surgeries provide facilities for patients to check their own blood pressure, often in the waiting room.  People can also get their blood pressure checked in most (60%) Oxfordshire pharmacies.

 We interviewed members of the public about self-screening: People who had checked their own blood pressure were curious about the result and found the service convenient.  Those that infrequently attended their GP surgery were unaware that such services existed. Others felt that there was no need to check or it was a medical thing, something they were unqualified to do.  We also interviewed potential and current service providers to find out more about the reasons for (not) offering blood pressure self-screening and how it worked on a day-to-day basis. 

As part of both sets of interviews, we discussed placing self-screening stations in the community. It was felt that it could improve awareness of the need to check your blood pressure. However there were concerns about the potential to cause anxiety without trained personnel nearby, and doubts as to whether people who were unlikely to go the GP surgery would use self-screening stations.

3. Pilot study to test self-screening for high blood pressure in GP surgeries and pharmacies

In this study, we will be putting blood pressure machines into the waiting rooms of GP surgeries and pharmacies. The machines will allow people to measure their own blood pressure, and will transfer the results to their electronic GP record if they want. This will allow their GP to see what their blood pressure was.

We will be installing machines into two GP surgeries and one pharmacy. We will partner with GP surgeries near the pharmacy, and patients of these surgeries will be able to transfer their readings if they wish. Anyone else will be able to use the machine, but their readings won’t go into their health records.

Each machine will be left in place for 12 months, so that we can find out how much they are used. If someone who uses the machine has a high blood pressure reading, they will be advised to see their GP or a nurse. Some of these people will have high blood pressure, and will need treatment.  We will follow people up using the data stored in the GPs electronic records, to see if they go to see the doctor, and whether they need treatment.

How this could benefit patients:

We know that some people with high blood pressure do not know about it. We think that self-screening might be a good way to find these people, particularly if they don’t see their GP very often. If we find that self-screening works, it will help the NHS to make decisions about how to use self-screening to detect high blood pressure.

Next steps:

We are currently recruiting sites for the pilot study. We hope that patients registered at the GP surgeries taking part in the study will be able to start using the blood pressure monitors from July  2015.