PERHIT - PERson-centredness in Hypertension management using Information Technology
Short description
Randomized and controlled study in primary care based on the person's participation in the treatment of high blood pressure through daily self-measurement with reporting of blood pressure, symptoms, side effects, mood and lifestyle. An interactive web-based system via mobile phone was used. After a pilot study together with 50 people, we tested in PERHIT, the use with 949 patients, at 31 healthcare centers and three healthcare regions. The use led to significantly more patients achieving the target blood pressure after the intervention was discontinued. Most patients and professionals were positive about using the system. Patients became more motivated to make lifestyle changes and became more active in their care. The fact that the patients took their medication had the strongest connection with blood pressure on the same day. Well-being, stress and restlessness were strongly related to blood pressure levels.
The system consisted of: (a) mobile phone (patient's own) for self-reporting of blood pressure, symptoms, medication adherence, side effects, lifestyle and well-being along with individualized reminders and encouraging messages for better lifestyles; (b) sphygmomanometer; (c) database for real-time recording of self-reported data entered by mobile phone (d) web-based feedback system that graphically displays collected self-reported data via the Internet accessible to patient and doctor/nurse.
Hallberg et al. Phases in development of an interactive mobile phone-based system to support self-management of hypertension, Integrated Blood Pressure Control, 2014 (7):19-28.
Short description of main results
Significantly more patients achieved target blood pressure after completing the intervention. Patients and professionals were positive about using the system. The patients became motivated to make lifestyle changes and be active in their care. The fact that the patients took their medicine had the strongest connection with blood pressure on the same day. Well-being, stress and restlessness were associated with blood pressure levels (Andersson et al 2024).
Every second patient experienced care that matched their wishes for participation in care. Women were more likely than men to be involved in their care. Younger people, and those with higher levels of education, felt that they had insufficient opportunities to participate in care based on their wishes. Patient participation improved in terms of; to be informed about what is being done for me and to manage my care on my own. (Hanna Vestala et al., 2024).
Scientific publications
Midlöv P, Nilsson PM, Bengtsson U, Hoffmann M, Wennersten A, Andersson U, Malmqvist U, Steen Carlsson K, Ranerup A, Kjellgren K. PERson-centredness in Hypertension Management Using Information Technology (PERHIT): A Protocol for a Randomised Controlled Trial in Primary Health Care. Blood Press 2020 Jun;29(3):149-156. doi: 10.1080/08037051.2019.1697177.
Andersson U, Bengtsson U, Ranerup A, Midlov P, Kjellgren K. Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone. J Med Internet Res. 2021 Jun 3;23(6):e26143. doi: 10.2196/26143.
Andersson U, Nilsson PM, Kjellgren K, Hoffmann M, Wennersten A, Midlov P. PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care J Hypertens. 2023 Feb 1;41(2):246-253. doi: 10.1097/HJH.0000000000003322.
Andersson U, Nilsson PM, Kjellgren K, Harris K, Chalmers J, Ekholm M, Midlöv P. Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care. J Hum Hypertens. 2023 Nov 15. doi: 10.1038/s41371-023-00874-2.
Vestala H, Bendtsen M, Midlöv P, Kjellgren K, Eldh AC. Is patient participation in hypertension care based on patients' preferences? - A cross-sectional study in primary healthcare. Eur J Cardiovasc Nurs. 2024 May 28:zvae085. doi: 10.1093/eurjcn/zvae085.
Andersson U, Nilsson PM, Kjellgren K, Ekholm M, Midlöv P. Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study. Scand J Prim Health Care. 2024 Mar 26:1-9. doi: 10.1080/02813432.2024.2332745.
Vestala H, Bendtsen M, Midlöv P, Kjellgren K & Eldh A-C: 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, Scand J Prim Health Care. 2024 Mar;42(1):225- 233. doi: 10.1080/02813432.2023.2301567.
Ekholm M, Andersson U, Nilsson PM, Kjellgren K, Midlöv P. Evaluation of self-monitoring of blood pressure in the PERHIT study and the impact on glomerular function. Blood Press. 2024 Dec;33(1):2399565. doi:10.1080/08037051.2024.2399565. Epub 2024 Sep 9. PMID: 39250514 Clinical Trial.
Andersson U, Nilsson P, Kjellgren K, Midlöv P. Personcentrerad behandling i primärvård av högt blodtryck med hjälp av ny informationsteknologi. Allmän Medicin 2021(4):16-17.
Andersson U. E-hälsa i behandling av högt blodtryck i primärvård. Allmän Medicin 2024 nr 3.
Nilsson PM. När hypertoniriktlinjer möter vårdens verklighet – hur utveckla en hållbar hypertonivård? Vaskulär medicin 2024(3): 21-23.
Researchers
Patrik Midlöv, professor Lund University
Karin Kjellgren, professor emerita, Linköping University
Peter Nilsson, professor Lund University
Agneta Ranerup, professor, Gothenburg University
Ulrika Bengtsson, University Lecturer, University of Gothenburg
Mikael Hoffman, PhD, Linköping University
Ulrika Andersson, general practitioner, PhD, Lund University
Katarina Steen Carlsson, researcher, Lund University
Hermansson-Borreback, general practitioner, PhD student, Lund University
Hanna Vestala, PhD student, Linköping University
Ann Catrine Eldh, professor, Linköping University