How to manage post-partum blood pressure sustainably?

Problem

Hypertensive disorders of pregnancy (HDP) occur in 8-10% of patients and can result in mortality and morbidity for mother and foetus. Improved post-natal management of HDP results in better health short term (stable blood pressure (BP)), and longer-term improved cardiac re-modelling with predicted decreased risk of stroke and end-stage kidney disease. However, management of hypertension post-partum requires frequent monitoring (up to daily for several weeks) which can be challenging within health systems in the UK and internationally. The inability to meet these monitoring recommendations often results in patients missing opportunities to manage their BP optimally and reduce subsequent complications. These gaps in provision disproportionately affect underserved groups including patients from minoritized ethnic communities. This project aimed to develop an intervention to improve blood pressure self-management post-partum. For the intervention to be sustainable it needed to be feasible and practicable in different contexts and for a diverse range of patients. Sustainability was also sought by ensuring the intervention was compatible with current practice, enhanced efficiency by decreasing clinician burden while simultaneously empowering the patient.

Approach

Using the person based approach (PBA), an intervention was co-produced with members of a patient and public involvement panel (PPI) and other stakeholders including clinicians, academic researchers, community and policy experts. PPI members had personal experiences of HDP. PPI were recruited from groups with worse maternal outcomes including under-resourced areas, minoritised ethnic groups, lower levels of education and physical impairment. Between January 2023-February 2024 nine PPI group and one-to-one meetings were held. Different elements of the intervention were discussed and the language, images, format and form carefully designed to enhance their comprehensibility, simplicity of use, practicability across different settings and patient safety. In terms of behaviour change support, the intervention drew on Bandura’s Social Cognitive Theory. Think-aloud interviews with patients and clinicians were used to optimise the intervention.

Findings

A digital intervention was co-produced which provides the basis for recording self-monitored BP and communicating it to clinicians (midwives and GPs). The intervention also records patient medication and prompts clinicians when medication changes may be needed. Accompanying the intervention is a motivating leaflet for patients to refer to while at home, as well as a clinician website offering all the latest NICE guidance on patient BP management post-partum. Conclusion: Using co-production with a varied group of stakeholders and PPI, this study developed an intervention that could be sustainably incorporated into usual care.

Consequences

This intervention will shortly be trialled across around 25 areas in England. If successful, it could support better, more efficient and sustainable management of post-partum BP in primary care.