University Hospitals of North Midlands NHS Trust
Gwyneth Lawson – CNS Hypertension
The Kidney Unit at the Royal Stoke University Hospital have embraced the opportunity to integrate Flo into their hypertension clinic pathway enabling patients to become more motivated and engaged in taking their pre-clinic home blood pressure readings whilst more reliably providing valuable diagnostic information for discussion at their appointment.
Led by Gwyneth Lawson, CNS Hypertension, patients are invited to use Flo by the Doctors and Nurses in clinic as an alternative to a paper based diary with patients remembering to take, then write down their reading one-week prior to their appointment and bring the readings along. The team opportunistically identifies patients in clinic with Flo also being used to contact patients to remind them that the following week is their clinic appointment and the reason for requesting BP readings.
Gwyneth comments:
“Flo makes it easier for patients to remember to take their blood pressure in the week before clinic and have the readings available for their appointment. Patients readings sent via Flo provide the necessary starting point for the clinical conversation as the information required is already there in front of the Doctor. Having the patient’s blood pressure readings makes the clinic run more smoothly and appointments not only faster but aids clinical decision making”
Home based blood pressure readings are an important part of the effectiveness of hypertension clinic appointments offering clinicians an insight into the patient’s blood pressure readings in their normal environment upon which to make decisions for further condition management. Patients who attend clinic without this information lack an important part of the puzzle required to effectively manage their condition, which can mean that it takes longer to achieve optimal blood pressure control.
Patient’s readings sent via Flo are used in conjunction with an in-clinic blood pressure reading to titrate or change medication, identify poor blood pressure technique at home and to enable clinical decision making; increasing the overall value of the clinic appointment. Where a significant discrepancy is identified between home and clinic blood pressure readings, the opportunity arises for the team to reconfirm good blood pressure reading technique with patients and if necessary provide valuable education to patients regarding how to accurately take their blood pressure.
Being able to offer Flo to patents at clinic also creates an opportunity to reinforce patient education around what the patient’s target blood pressure at home should be.
For patients with suspected white coat hypertension, following a high blood pressure reading indicated in clinic, those patients using Flo have negated the need for additional 24-hour blood pressure monitoring at home readings are already readily available confirming lower blood pressure readings outside of the clinic environment. This helps reduce costs which are associated with having to do 24 hour blood pressure monitoring and the time and cost to the patient coming to the hospital ; or going to their GP; once to have the monitor fitted and then to return the monitor.
Patients report that Flo is a convenient reminder and method of ensuring that this valuable information is present at their appointment and develop a greater understanding of the importance of monitoring their blood pressure.
Patient comment:
“Having Flo is a great reminder that my clinic appointment is next week, and that it is important that I send my BP readings every day for 1 week. Flo helps to remind me to take my blood pressure and I don’t have to remember to bring a piece of paper as I know the hospital already have my readings which makes my appointment quicker and gives us the chance to discuss other aspects of my condition such as medication and lifestyle “
Where patients struggle to attend clinic leading to DNA’d appointments, but demonstrate compliance with sending in their home readings to Flo, upon review of satisfactory home readings, patients are able to be discharged back to the care of the GP in the knowledge that home BP readings are stable, maximising clinic efficiency and capacity whilst ensuring that the patient is being managed in the most appropriate part of the system.
Gwyneth has expanded Flo’s offering to those patients who benefit from 3-4 days of blood pressure monitoring post clinic where medication has been changed, extending the insight that clinicians have post medication change.
Upon discharge from clinic, an average of the patient’s home blood pressure readings sent via Flo is available to their GP in support of the patient’s ongoing management.
For more information please contact Gwyneth Lawson, CNS Hypertension gwyneth.lawson@uhns.nhs.uk
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