At HTN Now we were joined by Generated Health’s chief medical officer Dr Jonathan Serjeant and commercial director John Griffiths.
Jonathan and John discussed the ways that digital is changing the realities of care for patients with hypertension, along with providing an overview of Florence, Generated Health’s intelligent messaging platform, with particular focus on blood pressure management.
Identifying the problem
Jonathan began by sharing some insights from spending the last year looking at how hypertension is currently supported. Generated Health has been working with a number of customers around the country, including Sussex and BLMK ICS , where they have been collaborating with system leaders on cardiovascular prevention.
“There are about 8.4 million people diagnosed with hypertension in England, or about 14 percent of your practice population,” he said. “However, statistics from 2021-2022 show that 6 percent had had no blood pressure reading in the last 12 months. 43 percent of people under 80 have uncontrolled blood pressure, and 28 percent of older hypertensive patients have uncontrolled blood pressure. That’s 4 million people with hypertension and unknown or uncontrolled blood pressure.”
Jonathan states that after an entire year of BP@Home, QOF outcomes for 2022/2023 revealed that around 1,000 practices still have around 50 percent of people with uncontrolled blood pressure.
Generated Health has been working to alleviate the pressures that primary care practices face through use of their Florence solution, which reduces administrative work for practices and supports patients to manage their own care through simple text messaging algorithms.
Jonathan highlighted that the costs involved with diseases caused by high blood pressure, such as stroke, coronary heart disease, chronic kidney disease and vascular dementia, cost the NHS £2.1 billion every single year.
“If we can just manage blood pressure well, we can have a huge impact,” Jonathan emphasised. “And as I’ve heard from the chair of the Health Select Committee, it is doable, because we can identify people, and we can help them take their meds well.”
The associated challenges
Jonathan talked about the challenges with hypertension management; for example, patients often do not come forward and ask for help, because they generally feel well. He also pointed to the “abstract” nature of high blood pressure itself, indicating that patients often are not sure what exactly this means, or what its implications are.
“As GPs, how do you explain to people this risk of having a heart attack or stroke in the next 10 years? That’s a difficult concept to grasp,” he said. “And we have to maintain their engagement – so how do we remind people that their blood pressure control is important whilst they’re leading really busy lives?”
Jonathan drew attention to the concept of behavioural change, and the potential to help patients realise the kinds of benefits associated with different changes in behaviour. Eating more healthily, for example, could result in a reduction of up to 11mmHg in systolic blood pressure.
Blood pressure monitoring at home
The discussion moved on to the ways that at-home blood pressure monitoring could help to overcome some of the behavioural challenges associated with hypertension management. Jonathan pointed to the benefits of home blood pressure readings with regards to giving patients objective feedback on their health, demonstrating the need to make changes, and increasing their engagement with self-management and behavioural change.
“HealthWatch did a survey on how people manage their blood pressure at home, and we discovered that a lot of people did get a blood pressure monitor to help them improve their health,” Jonathan said. He explained that 50 percent of patients responded that they owned a blood pressure machine, and 90 percent of those could use the machine in an effective way.
What is lacking, according to Jonathan, is follow-up and continuous messaging to people. He shared that only 30 percent of the patients HealthWatch questioned had been prompted to measure their blood pressure at home; 15 percent were unsure what their reading actually meant; and 33 percent were unsure as to why they were actually measuring their blood pressure.
“Educating patients on how to take their blood pressure properly – so they haven’t just walked up the stairs, got out of bed, gone for a run or drunk a cup of coffee – is really important,” Jonathan emphasised. “Also, getting people to take readings at a frequency which helps clinicians with decision making is important.”
Jonathan touched on some of the challenges which can arise from at-home blood pressure monitoring for practices, acknowledging that if you have lots of patients presenting blood pressure readings, a practice can feel overwhelmed by the workload. “But actually, if you have a system and a piece of technology that advises people about what to do with those blood pressures, you don’t have that workload landing at your door.”
How Florence is helping to overcome challenges in home blood pressure monitoring and hypertension management
Jonathan then moved onto Generated Health’s work to develop a solution to remote patient monitoring for hypertension, which can overcome the burden for practices and improve education for patients.
“Over the last eight years we’ve been providing remote monitoring blood pressure work,” he said. “In the last 18 months, we’ve been working with some key customers around the country, at place level and ICB level, to provide intelligent messaging communication by simple SMS text. We’ve been focused on hypertension management; because if we do focus on it, we can make a difference.”
Traditionally, he said, patients would monitor blood pressure at home, send it to the practice, and the clinician would then advice patients on health and behaviour changes. This relies heavily, however, on patient engagement, motivation, attendance and adherence with proposed courses of action.
“Florence has designed a complex set of algorithms,” he explained. “A patient onboards themselves to the algorithm, checks are run to ensure that they’ve got a blood pressure monitor. They provide their blood pressure readings and Florence will give them feedback to say if it’s a bit high or tell them not to worry. That makes sure we get the averages that we need. At the same time it educates the patient, giving people information about their smoking, their physical activity, diet stress, and critically, their medication adherence.”
After gleaning this integral information from patients, Florence engages the patients on a deeper level, asking them questions about their health and what is important to them, encouraging and promoting self-management.
“It gets into conversation with the patient, asking ‘what’s important to you?’ We can signpost them to the right services, we can support them with physical activity, we can support them with medication adherence.
Florence also provides an insight into various social determinants of health, people’s access to healthcare, and what kind of health inequalities are being created.
“We’ve tried to create a whole package, for the whole pathway, for you at a whole place,” said Jonathan. “That could mean supporting you in finding the right people, case finding; we have people to make sure you find that cohort. We provide the automated patient monitoring, the feedback to patients so that they know what is happening and can be reassured; and all that information goes into the medical record. We provide blood pressure monitors if practices need them, and we provide the focus on patient education, behavioural change and the wider determinants. ”
Having all of this in one place is one of the major benefits of Florence, Jonathan said. It acts as a portal for pharmacists, nurses, GPs and other clinical staff, enabling them to access all of the relevant information in the same place. Florence also provides training, if needed, to help ensure that practices are supported in making the change.
Better patient outcomes, increased efficiency and cost savings
Jonathan spoke of the work that Florence can do to improve patient outcomes and save time.
“If you need to titrate people up, our algorithms can help you to do that in a way which reduces the need for multiple clinician input. For example, a use case of Florence in Bedfordshire shows that you can get people onto dual therapy in about two clinical consultations rather than ten. So there’s a significant saving in supporting people with uncontrolled hypertension.”
There are significant benefits for population blood pressure management, Jonathan continued; patients can be uploaded in bulk to the platform, and the ones needing intervention can easily be picked up by practices for further check-ups.
Florence can help to achieve clinical capacity and to undertake clinical reviews, providing workflow and even sourcing locum pharmacists who can run virtual clinics. Project management support is also available for those practices who need it.
After working with several different ICSs, the process of adoption and integration has been refined. John joined the discussion to comment on the success of the solution for those early adopters. “We’ve worked with four or five different ICSs over the past 12 months to implement this at scale. We’ve got a pretty good process now for getting this implemented, adopted, and loved across PCNs, place and ICSs.” He added that co-design is “absolutely key” to success.
John went on to describe how monthly and quarterly feedback sessions allow Generated Health to continue to develop and tweak Florence to suit demand and requirements.
“We’re now well versed in a lot of the challenges our customers experience when they deploy a technology at scale,” John said. “We appreciate that it’s a change, and that it’s a slightly new way of working. I think we’ve got to the point now where we have a robust structure.”
John finished up the session by talking about the TARGETBP programme, which aims to enable patients to care for themselves, to reduce work in clinical teams, and to improve health outcomes across the board.
“Clinical outcomes do not get better by monitoring patients alone, you have to give patients the opportunity to learn and break bad habits, and to form healthier new ones, and that’s what we see from our evidence time and time again.”
Many thanks to Jonathan and John for joining us.