to encourage patients to participate in the process of monitoring, evaluating and responding to the treatment of chronic diseases in general will help solve many outstanding problems now and in the future when the Vietnamese health system is increasingly facing the rapidly increasing burden of non-communicable diseases and health problems due to the rapid aging of the population. Help increase efficiency and provide a method of self-communication in the community, increase people's understanding and concern about the disease and possibly improve the current situation of proactive diagnosis and early diagnosis of hypertension, which is still very limited.
With a simple form and easy to apply in the community, the intervention packages have also contributed to increasing the effectiveness of patient participation in disease self-management, an activity recommended by CDC and WHO but not yet implemented well in practice, while reducing clinical inertia for physicians when treating chronic patients.
4.6.5 Strengths and limitations of the study Novelty of the study:
With the intervention model applying many groups of solutions to impact on increasing the rate of self-monitoring of blood pressure, maintaining medication use and improving treatment adherence, the organization is quite complicated, requiring a clear structure and close coordination with local health care, while receiving the support of patients in the community.
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Results in Increased Knowledge and Skills in Self-Monitoring Blood Pressure -
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Limitations of the Study and Future Research Directions -
Overall Assessment (Strengths, Limitations and Causes) -
Average Vmtt Thickness of High Blood Pressure and Normal Blood Pressure Groups
The research site is far from Hanoi and difficult to travel to, but thanks to the close connection and support of the District General Hospital, the organization and implementation were smooth and convenient.
The strength and also the novelty in choosing the intervention model is that the researcher conducted the initial assessment based on a standardized and familiar measurement tool for cardiology in Vietnam, which is valuable in helping to closely assess the status of treatment compliance before the intervention. The assessment of the self-monitoring blood pressure practice index, although a new index, the researcher measured it based on a combination of two tools: interview and observation according to a checklist to increase the reliability of the information obtained. Scale for assessing correct blood pressure measurement practice
The method is based on the standards of the Vietnam Hypertension Association, which are specified into 5 criteria on the checklist, so it allows better measurement of skills than just through interviews.
The outstanding new point in the intervention model is the finding of a gap and the decision to choose to build a Blood Pressure Interpretation and Self-Monitoring Support Board for patients - a new tool that has not been built yet and requires high consensus, which led to the need to add a research component to build a Blood Pressure Interpretation and Self-Monitoring Support Board using the Delphi method and then assess patient acceptance before implementing the intervention. The application of a component study with an underused method has given graduate students the opportunity to learn more and demonstrate seriousness in the course's research process.
Thus, by identifying and setting up studies and searching for optimal response methods, the researcher designed and completed the implementation of a multi-phase intervention study with interwoven methods, in a difficult area over a long period of time. This process helped the researcher accumulate research experience, continuous learning, and extremely valuable and useful community implementation skills.
Limitations of the study
The most important limitation of the study is the sampling defect, which includes:
- Defects in the age of the study subjects: To meet the set sample size, the study selected all patients who met the diagnostic criteria and only excluded those who were elderly or changed their place of residence during the intervention period. Therefore, based on the available screening results at the district level, the group of patients in the study fell between the ages of 51-80, making it difficult to compare with other studies because the study subjects included both middle-aged and elderly people.
- The second selection defect is the selection of the control commune, in which the researcher had to choose a commune in the Nam Tien Hai area, in the same district as the intervention communes. Although it has been overcome
The study was limited by excluding the communes that conducted the acceptance assessment and selecting communes that were distant from the experimental and intervention communes, but this was also a limitation that could have affected the results of the study because the control subjects heard and knew the information and intervention tools.
The second limitation is due to the short intervention period, so the results obtained after the intervention may be temporary and cannot confirm the sustainability of the solutions as well as their effectiveness. The researcher overcomes this by seeking resources to conduct more studies with longer duration and more rigorous design.
Chapter 5 CONCLUSION
Before the intervention, in 2015, the situation of self-monitoring of blood pressure at home and adherence to medication of hypertensive people aged 50 and over in some communes of Thai Binh and Hung Yen provinces had many limitations, specifically:
- 63.6% of patients believe that it is necessary to monitor blood pressure regularly. In particular, the concept of people with high blood pressure about self-monitoring blood pressure is very different, some patients already know and think that self-measuring blood pressure is necessary and can be done well by themselves, but the majority of patients think that self-monitoring blood pressure is the responsibility of medical staff.
- 53% of patients monitored their blood pressure at home while 47.0% of the study patients did not.
- Logistic regression analysis showed that male patients tended to self-monitor their blood pressure better than female patients, and the group under 70 years old monitored better than the elderly group. In particular, having a home blood pressure monitor and knowing how to self-measure greatly affected the patient's self-monitoring of blood pressure, while living with a spouse or having good knowledge about blood pressure monitoring or not were not significantly related to self-monitoring of blood pressure.
The intervention model was developed and applied to 151 hypertensive patients living in some communes of Tien Hai district with 3 main intervention solutions to enhance self-monitoring of blood pressure and treatment adherence in patients. The intervention was implemented for over 90% of patients in the intervention group, ensuring the expected contents. During the 5-month intervention period, there were no cases of changes in study subjects, no cases of patient death or change of residence. The results of the intervention model evaluation are as follows:
- Regarding knowledge, the intervention helped increase 26.4% of patients knowing that regular blood pressure monitoring is necessary and this change is statistically significant.
- The intervention increased the proportion of patients with correct self-measurement of blood pressure by 17.6%. However, the difference was not statistically significant.
- In terms of practice, the intervention resulted in a 36.4% increase in the number of patients who regularly measured their blood pressure at home and a 59.9% increase in the proportion of patients who recorded their blood pressure readings when they were measured. The change was statistically significant.
- In particular, in terms of improving treatment adherence, the intervention helped increase the proportion of patients taking antihypertensive medication by 29.2% and the proportion of patients adhering to treatment by 22.6%. The difference was statistically significant. Compared with all the intervention objectives, including increasing the number of patients practicing home blood pressure monitoring by 30%; increasing the proportion of patients taking medication by 15% and increasing the proportion of patients adhering to treatment, the intervention model achieved its objectives.
- The logistic regression model allows to conclude that the intervention has helped increase the rate of patients who know to monitor their blood pressure regularly at home but has not really increased the number of patients who know how to measure their blood pressure correctly. In addition, it can also be seen that the intervention has helped to significantly improve the practice of self-monitoring blood pressure at home, recording blood pressure indexes in a statistically significant way. Regarding the practice of taking medication and adherence to treatment, taking medication and adherence to treatment have also improved significantly thanks to the intervention model.
Chapter 6 RECOMMENDATIONS
There is a need for further research on models that encourage patients to self-monitor their treatment progress and outcomes at home, increasing their connection with their doctors through simple support tools that are appropriate to Vietnamese culture.
The intervention model shows that the consulting activities of treating doctors for patients on medication use and avoiding side effects are very important and practical, and should be included in the outpatient management and treatment process to be implemented and monitored at medical facilities as well as included in the payment list under health insurance, especially for non-communicable diseases.
It is necessary to increase the forms of mobilizing family and community participation in reminding, encouraging and creating a favorable environment for patients to adhere to the treatment regimen.
The table of interpretation and support for self-monitoring of blood pressure is a new product of research, so it needs to be copyrighted to ensure that it is not copied and the interpretation ranges are not distorted. At the same time, suitable versions for many specific patient groups with different cardiovascular risk stratifications should be developed, popularized in the national program to become a widely popular product in the community.
Recommendations for researchers: Open a research direction in developing tools to support patients in self-monitoring non-communicable diseases requiring long-term treatment in the community. At the same time, use it as a tool to support the collection of self-reported data honestly. Medical facilities can use the Interpretation Board to increase the connection between doctors and patients and monitor patients during out-of-hospital time, improving treatment effectiveness.
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