Hypertension
Telemanagement of hypertension: A qualitative assessment of patient and physician preferencesLa prise en charge de l’hypertension à distance : Une évaluation qualitative des préférences des patients et des médecins

https://doi.org/10.1016/S0828-282X(07)70807-3Get rights and content

Background

Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25%. Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure. Major design flaws and high operating costs, however, have hindered its adoption by physicians and patients.

Objectives

In the present commentary, the field of telemedicine, as it pertains to hypertension management, is reviewed, and the investigators’ experiences in developing a new telemedicine system are outlined.

Methods

An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system. Opinions were elicited separately from type 2 diabetic patients with hypertension (n = 24) and family practitioners in active clinical practice (n = 18).

Results

Physician and patient focus group meetings provided key information that led to changes in the prototype system. The low level of computer and Internet use by patients in everyday life and by physicians in practice-related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts. For patients, the mobile phone appeared to be an acceptable alternative. The only practical, automated means to disseminate reports and alerts to physicians was by fax, which was the most universally available device in a doctor's office.

Conclusion

This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness.

Historique

Les études de prévalence révèlent constamment que le taux de contrôle de la tension artérielle (TA) chez les hypertendus est inférieur à 25%. Les études sur la télémédecine comme moyen de soigner les hypertendus ont démontré que cette démarche est efficace pour abaisser la TA. Cependant, d’importants défauts de conception et des frais d’exploitation élevés ont empêché leur adoption par les médecins et les patients.

Objectifs

Dans le présent commentaire, on examine le domaine de la télémédecine pour la prise en charge de l’hypertension et on expose les expériences des chercheurs dans l’élaboration d’un nouveau système de télémédecine.

Méthodologie

Une étude de cas qualitatifs appliquée a permis de déterminer les besoins d’information nécessaires pour concevoir un système de télémédecine. On a obtenu l’avis distinct d’hypertendus atteints de diabète de type 2 (n = 24) et de médecins de famille en pratique clinique active (n = 18).

Résultats

Des réunions des groupes de travail de médecins et de patients ont fourni de l’information capitale qui a suscité des changements au système prototype. La faible utilisation des ordinateurs et d’Internet par les patients dans leur vie quotidienne et par les médecins dans les activités reliées à leur pratique ont empêché leur inclusion dans le système afin d’extraire des données et de recevoir des avertissements cliniques. Pour les patients, le téléphone cellulaire semblait constituer une solution acceptable. Le télécopieur était le seul moyen pratique et automatisé pour diffuser les rapports et les avertissements aux médecins, l’appareil le plus universellement présent au cabinet du médecin.

Conclusion

L’étude qualitative bien circonscrite a donné lieu à l’élaboration des principes de conception d’un système prototype afin d’accroître la probabilité d’acceptation par l’usager et l’amélioration de son efficacité.

References (17)

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