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Telemonitoring at scale for hypertension in primary care: An implementation study

Hammersley, Vicky; Parker, Richard; Paterson, Mary; Hanley, Janet; Pinnock, Hilary; Padfield, Paul; Stoddart, Andrew; Park, Hyeon Gyeong; Sheikh, Aziz; McKinstry, Brian


Vicky Hammersley

Richard Parker

Hilary Pinnock

Paul Padfield

Andrew Stoddart

Hyeon Gyeong Park

Aziz Sheikh

Brian McKinstry


While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care.

Methods and findings
This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants’ views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56–70, range 22–89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6–10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy.

Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative.


Hammersley, V., Parker, R., Paterson, M., Hanley, J., Pinnock, H., Padfield, P., Stoddart, A., Park, H. G., Sheikh, A., & McKinstry, B. (2020). Telemonitoring at scale for hypertension in primary care: An implementation study. PLoS Medicine, 17(6), e1003124.

Journal Article Type Article
Acceptance Date May 22, 2020
Online Publication Date Jun 17, 2020
Publication Date Jun 17, 2020
Deposit Date Jun 18, 2020
Publicly Available Date Jun 18, 2020
Journal PLOS Medicine
Print ISSN 1549-1277
Electronic ISSN 1549-1676
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 17
Issue 6
Pages e1003124
Keywords telemonitoring; hypertension; clinical practice; blood pressure
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Copyright Statement
© 2020 Hammersley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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