Home Monitoring: Patient and Provider Perceptions of and Use of Home Blood Sugar and Blood Pressure Measurements in Primary Care Practice

Background/Aims: Patients with diabetes and hypertension are increasingly asked to monitor blood glucose and blood pressure at home. Home monitoring and the resulting logs and measurements are sometimes used as a basis for adjusting treatment. Despite the importance of home monitoring, we lack an understanding of patients’ ability and education about how to take accurate measurements, their perception of what to do with these measurements, and how providers use these measurements in practice. Methods: Findings are drawn from a mixed-methods study of a primary care intervention for patients with diabetes and hypertension. The study was conducted at a large multispecialty clinic serving approximately 29,000 patients with diabetes or hypertension. Data include discussion of home monitoring in observation/audio recording of 26 primary care appointments, and interviews with 12 patients, 7 medical assistants and 9 physicians. Results: The intervention standardized procedures for collecting patients’ home blood sugar and blood pressure measurements and logging them in the electronic health record. However, there was no standardization of the procedures or tools patients used to collect this data. Patients described various motivations for home monitoring, ranging from physician requests to adjusting daily insulin dosage. Several patients were uneducated about how to take measurement, e.g. what “fasting blood sugar” meant. Some patients were unsure what to do if measurements were too high or too low. Other patients lacked training and reported problems using devices. Physicians often asked patients to call in/email measurements after appointments or medication changes. Increasingly physicians appear to be using these home measurements for clinical decision-making, yet the reliability of these measurements may vary widely. Discussion: Home monitoring offers an opportunity to further engage patients in their care and provides an opportunity to help them better understand how blood pressure and blood sugar affects their health. However, patients exhibit varying strategies of when, how and why to check their blood sugar and blood pressure. Relying on patient-collected data may result in problematic clinical decisions, and there is a need for consistent and early patient education to ensure accurate home monitoring and steps to take if numbers are either too high or too low