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Are self-reported telemonitored blood pressure readings affected by end-digit preference: a prospective cohort study in Scotland

Parker, Richard A; Paterson, Mary; Padfield, Paul; Pinnock, Hilary; Hanley, Janet; Hammersley, Vicky S; Al-Remal, Mohammad; Steventon, Adam; McKinstry, Brian

Authors

Richard A Parker

Paul Padfield

Hilary Pinnock

Vicky S Hammersley

Mohammad Al-Remal

Adam Steventon

Brian McKinstry



Abstract

Objective Simple forms of blood pressure (BP) telemonitoring require patients to text readings to central servers creating an opportunity for both entry error and manipulation. We wished to determine if there was an apparent preference for particular end digits and entries which were just below target BPs which might suggest evidence of data manipulation.
Design Prospective cohort study
Setting 37 socio-economically diverse primary care practices from South East NHS Lothian, Scotland.
Participants Patients were recruited with hypertension to a telemonitoring service in which patients submitted home BP readings by manually transcribing the measurements into text messages for transmission (‘patient-texted system’). These readings were compared to those from primary care patients with uncontrolled hypertension using a system in which readings were automatically transmitted, eliminating the possibility of manipulation of values (‘automatic-transmission system’).
Methods A Generalised Estimating Equations method was used to compare BP readings between the patient-texted and automatic-transmission systems, while taking into account clustering of readings within patients.
Results A total of 44,150 BP readings were analysed on 1,068 patients using the patient-texted system compared to 20,705 readings on 199 patients using the automatic-transmission system. Compared to the automatic-transmission data, the patient-texted data showed a significantly higher proportion of occurrences of both systolic and diastolic BP having a zero end digit (OR 2.1, 95% CI 1.7 to 2.6) although incidence was less than 2% of readings. Similarly, there was a preference for systolic 134 and diastolic 84 (the threshold for alerts was 135/85) (134 systolic BP OR 1.52, 95% CI 1.28 to 1.82; 84 diastolic BP OR 1.54, 95% CI 1.28 to 1.86).
Conclusion End-digit preference for zero numbers and specific value preference for readings just below the alert threshold exists among patients self-reporting their BP using telemonitoring. However, the proportion of readings affected is small and unlikely to be clinically important.

Journal Article Type Article
Acceptance Date Dec 7, 2017
Online Publication Date Jan 31, 2018
Publication Date Jan 31, 2018
Deposit Date Dec 12, 2017
Publicly Available Date Dec 12, 2017
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Article Number e019431
DOI https://doi.org/10.1136/bmjopen-2017-019431
Keywords End digit preference, terminal digit preference, blood pressure control, hypertension, telemedicine
Public URL http://researchrepository.napier.ac.uk/Output/1018475
Contract Date Dec 12, 2017

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/4.0/
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


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