Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension – a randomized controlled trial in primary care

Abstract

Objective

To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only).

Design

A parallel group, non-blinded, randomized controlled trial, conducted October 2018–February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement.

Setting

31 primary healthcare centers in Sweden.

Subjects

949 patients treated for hypertension.

Main outcome measures

The effects on preference-based patient participation, that is, the match between a patient’s preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression.

Results

At baseline, 43–51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for ‘managing treatment myself’ at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months.

Conclusion

The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.

KEY POINTS

• Although patient participation is essential when having a long-term condition, interventions optimizing individuals’ engagement have not been fully identified.

• About half of the patients with hypertension in this study did not experience participation in the manner and extent they preferred.

• A web-based support system via mobile phone improved some aspects of patient participation in the short- but not long term.

• Strategies to better identify patients’ preferences for patient participation are needed, to evaluate and improve the outcome of care.

Keywords:

• E-health
• hypertension
• patient engagement
• patient participation
• preferences
• primary healthcare
• self-management

Disclosure statement

No interests to declare; the 4Ps tool is protected by copyright, but available from the last author for free, given agreement on standards for its use.

Practice implications

Healthcare professionals guided by how and to what extent patients’ wish to engage can direct their efforts in accord. For patients with hypertension, this seems an appropriate issue to address, along with managing treatment, symptoms and learning about plans for their treatment.

Additional information

Funding

This work was supported by the Kamprad Foundation under Grant 20170102; the Heart and Lung Foundation under Grant 20170251 and Grant 20200507; the Swedish Research Council under Grant 2018-02648, and Gothenburg University Centre for Person-Centered Care (GPCC).