What are primary care professionals’ views on patients’ use of self-monitoring technologies at home?

Problem

The arrival of new technologies features prominently in the New Declaration for Primary Health Care, where it is predicted that these will ‘enable individuals and communities to identify their health needs [..] and play an active role in maintaining their own health and wellbeing’. Technology also constitutes a main theme in the UK government’s Long Term Plan for the National Health Service in England. Here, it is suggested that within the next ten years we will be able to ‘effortlessly’ monitor physiology, using ‘intuitive’ and ‘straightforward’ healthcare technologies. However, such views of technology in the area of self-monitoring may be over-optimistic, ignoring the real-life complexities of its implementation. In this study, we explored GPs’ and practice nurses’ (PNs) views and experiences of patients self-monitoring, in the specific cases of blood pressure and body mass index (BMI), where self-monitoring has been used for many years.

Approach

We sought the views of primary care professionals on the home use of blood pressure monitors and BMI scales, to examine the complexities still present in implementing well-established self-monitoring technologies. In a novel adaptation of vignette methodology, we presented excerpts from a large interview study with home users of blood pressure monitors and BMI scales, to general practitioners (GPs) and practice nurses (PNs). To date, we have completed one focus group with six GPs and two PNs, and we have plans to conduct four more groups in February and March 2019.

Findings

Preliminary findings suggest primary care professionals believe that self-monitoring technologies create the need for additional clinical time to educate patients on how best to self-monitor and manage their medication. This includes the importance of setting boundaries around the frequency and duration of self-monitoring to protect patients’ mental health. GPs and PNs also suggest that a lack of expertise in pharmacology may prevent patients from being truly empowered to effectively manage their own medication based on their readings. Furthermore, electronic transmission of readings and photos between patients and healthcare practitioners is seen as problematic, for reasons including information security, intellectual property and transcription accuracy.

Consequences

Our findings demonstrate the complexity involved in primary care interactions relating to two types of self-monitoring device that have been in use for many years. Thus, they draw attention to aspects of the implementation of these technologies that will require the most work to achieve the visions set out in recent policy documents. More immediately, these findings have implications for the management of self-monitoring practices in primary care, where, for example, healthcare assistants could be mobilised to provide additional support in order to facilitate patients’ effective use of self-monitoring technologies.