OBJECTIVES: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support.
METHODS: From a search of eight databases (January 1993-October 2012; update June 2017) we included systematic syntheses of qualitative studies of patients' experiences, and systematic reviews of randomized controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used meta-ethnography, meta-Forest plots and narrative analysis to synthesise the data.
RESULTS: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced SBP (by between 2 and 6 mmHg), and DBP (by between 1 and 5 mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients' perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient-professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension.
CONCLUSION: Our systematic qualitative and quantitative meta-reviews tell complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. HBPM (with or without telehealth) within the context of a supportive patient-professional partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status.
METHODS: Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively.
RESULTS: Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare.
CONCLUSIONS: This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women's experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities.
SYSTEMATIC REGISTRATION: Systematic review registration number: PROSPERO CRD42017073315 .
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services.
OBJECTIVES: To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review.
METHODS: We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries.
MAIN RESULTS: We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions.
AUTHORS' CONCLUSIONS: A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.
OBJECTIVES: To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.
METHODS: We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.
MAIN RESULTS: We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support.
AUTHORS' CONCLUSIONS: Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Diabetes is a common chronic disease that places an unprecedented strain on health care systems worldwide. Mobile health technologies such as smartphones, mobile applications, and wearable devices, known as mHealth, offer significant and innovative opportunities for improving patient to provider communication and self-management of diabetes.
OBJECTIVE: The purpose of this overview is to critically appraise and consolidate evidence from multiple systematic reviews on the effectiveness of mHealth interventions for patients with diabetes to inform policy makers, practitioners, and researchers.
METHODS: A comprehensive search on multiple databases was performed to identify relevant systematic reviews published between January 1996 and December 2015. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using AMSTAR.
RESULTS: Fifteen systematic reviews published between 2008 and 2014 were eligible for inclusion. The quality of the reviews varied considerably and most of them had important methodological limitations. Focusing on systematic reviews that offered the most direct evidence, this overview demonstrates that on average, mHealth interventions improve glycemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for patients with type 2 diabetes and 0.3% for patients with type 1 diabetes, at least in the short-term (≤12 months). However, limitations in the overall quality of evidence suggest that further research will likely have an important impact in these estimates of effect.
CONCLUSIONS: Findings are consistent with clinically relevant improvements, particularly with respect to patients with type 2 diabetes. Similar to home telemonitoring, mHealth interventions represent a promising approach for self-management of diabetes.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care.
OBJECTIVE: An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs.
METHODS: Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses' practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses' and patients' perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered.
RESULTS: A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses' competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status.
CONCLUSIONS: The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs' context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings.
TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh).
Las citas perdidas son un costo evitable y la ineficiencia de recursos que afecten a la salud de los pacientes y resultados del tratamiento. Los servicios de salud están utilizando cada vez más los sistemas de recordatorios para gestionar estos efectos negativos. Este estudio analiza la eficacia de los sistemas de recordatorio para la promoción de la asistencia, cancelaciones, y reprogramación de citas en todos los centros de atención de la salud y de los grupos de pacientes particulares y los factores contextuales que indican que los recordatorios se están empleando de forma subóptima. Se han utilizado tres exámenes interrelacionados de pruebas cuantitativas y cualitativas. En primer lugar, el uso de modelos y teorías preexistentes, hemos desarrollado un marco conceptual para informar a nuestra comprensión de los contextos y los mecanismos que influyen en la eficacia de recordatorio. En segundo lugar, se realizó una revisión siguiente Centro de Revisiones y Difusión directrices para investigar la eficacia de los diferentes métodos de recordar a los pacientes que asisten a las citas de servicios de salud. Por último, como complemento a la información de la eficacia, completamos una revisión informada por los principios realistas para identificar los factores que pueden influir en los comportamientos no-asistencia y la efectividad de los recordatorios. Hemos encontrado pruebas consistentes de que todos los tipos de sistemas de recordatorio son eficaces para mejorar la asistencia a las citas en una amplia gama de entornos de atención de salud y poblaciones de pacientes. sistemas de recordatorio también pueden aumentar la cancelación y reprogramación de citas no deseados. "Recordatorio plus", que proporciona información adicional más allá de la función de recordatorio puede ser más eficaz que los recordatorios simples (es decir, fecha, hora, lugar) a reducir la falta de asistencia a las citas en circunstancias particulares. Se identificaron seis áreas de ineficiencia que indican que los sistemas de recordatorio se están utilizando de forma subóptima. A menos que se indique lo contrario, todos los pacientes deben recibir un recordatorio para facilitar la asistencia a su cita de atención médica. La elección del sistema de recordatorio debe adaptarse al servicio individual. Para optimizar los sistemas de citas y recordatorios, los servicios de salud necesitan procesos administrativos de apoyo para mejorar la asistencia, la cancelación, reprogramación y reasignación de citas a otros pacientes.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
Servicio de mensajes cortos (SMS) Los mensajes pueden presentar un método conveniente y rentable para apoyar las intervenciones de salud. Este trabajo evalúa los efectos del servicio de mensajes cortos en diversas intervenciones de salud que se encuentran en las revisiones sistemáticas. La estrategia de búsqueda se basa en dos conceptos clave: el servicio de mensajes cortos y prestación de asistencia sanitaria. La búsqueda inicial se realizó en diciembre de 2012 y fue actualizado en junio de 2013. De las 550 referencias identificadas, 13 revisiones sistemáticas cumplieron los criterios de inclusión, de los cuales 8 fueron publicados en revistas revisadas por pares y 5 fueron recuperados de la biblioteca Cochrane. Análisis de los datos muestra que baja a moderada evidencia de investigación existe sobre los beneficios de las intervenciones de servicios de mensajes cortos para recordatorios de citas, la promoción de la salud en los países en desarrollo y de salud preventiva. En muchas de las intervenciones, sin embargo, hubo algunos estudios que eran de alta calidad, y la mayoría de los estudios se calificaron de calidad baja a moderada o tenido sin valoraciones en absoluto. Las organizaciones de salud, responsables políticos, o los médicos que utilizan los mensajes de servicio de mensajes cortos para apoyar las intervenciones de salud deben (1) implementar intervenciones que se han encontrado para trabajar en establecimientos de salud, (2) continuar la evaluación de intervenciones de los servicios de mensajería corta que no han sido evaluados adecuadamente, y (3) mejorar la colaboración entre las distintas entidades de salud para desarrollar estudios dirigidos a poblaciones específicas para evaluar el impacto a largo plazo del servicio de mensajes cortos en los resultados de salud.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BackgroundStrong compromiso internacional y el uso generalizado de la terapia antirretroviral han llevado a una mayor longevidad de las personas que viven con el virus de inmunodeficiencia humana (VIH). Intervenciones de mensajería de texto se han demostrado mejorar los resultados de salud en las personas que viven con el VIH. Los objetivos de esta revisión fueron: Mapa del estado de la evidencia de las intervenciones de mensajería de texto, identificar las brechas de conocimiento, y desarrollar un marco para la transferencia de datos a otras enfermedades crónicas.MethodsWe realizó una revisión sistemática de las revisiones sistemáticas sobre las intervenciones de mensajería de texto para mejorar la salud o los resultados de salud relacionados. Se realizó una búsqueda exhaustiva en PubMed, EMBASE (Exerpta Medica base de datos), CINAHL (Cumulative Index de Enfermería y Salud Aliada Literatura), PsycINFO, Web of Science (WoS) y la Biblioteca Cochrane en el 17 de abril 2014. Proyección, extracción y evaluación de la calidad metodológica de datos se realizaron por duplicado. Nuestros resultados se utilizaron para desarrollar un marco conceptual para la transferencia.ResultsOur búsqueda identificó 135 posibles revisiones sistemáticas de los cuales nueve fueron incluidos, al informar sobre 37 estudios de origen, llevados a cabo en 19 países diferentes. Siete de nueve (77,7%) de estas críticas eran de alta calidad. Hubo algunas pruebas para la mensajería de texto como una herramienta para mejorar la adherencia a la terapia antirretroviral. Los mensajes de texto también mejoraron asistencia a las citas y los resultados de cambio de comportamiento. Los resultados no fueron concluyentes para la autogestión de la enfermedad, el tratamiento de la tuberculosis y la comunicación de los resultados de las investigaciones médicas. La distribución geográfica de la investigación de mensajes de texto se limita a regiones específicas del mundo. Lagunas de conocimiento más destacados cabe mencionar la falta de datos sobre los resultados a largo plazo, la satisfacción del paciente, y evaluaciones económicas. Los comentarios incluidos también identificaron limitaciones metodológicas en muchos de los estudios primarios.Pruebas ConclusionsGlobal apoya el uso de la mensajería de texto como una herramienta para mejorar la adherencia a la medicación y la asistencia a las citas programadas. Dadas las similitudes entre el VIH y otras enfermedades crónicas (medicamentos a largo plazo, la atención de toda la vida, una fuerte vinculación con el comportamiento y la necesidad de apoyo en el hogar) pruebas de VIH pueden ser transferidos a estas enfermedades usando nuestro marco propuesto por la integración del VIH y servicios de enfermedades crónicas o la transferencia directa.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
ANTECEDENTES: La carga mundial de enfermedades crónicas es generalizado y creciente. Este cambio de aguda a la atención crónica requiere un replanteamiento de cómo se invierten los recursos en la gestión de estas condiciones. Una respuesta ha sido la creación de programas e intervenciones que tienen el objetivo de ayudar a los pacientes a manejar mejor sus propias condiciones. Con el tiempo, estas intervenciones y estrategias de autogestión han recurrido cada vez más diversas tecnologías para su aplicación, con la más nueva tecnología de ser teléfonos móviles y servicio de mensajes cortos (SMS).
OBJETIVO: El objetivo de este meta-revisión fue evaluar la evidencia actual sobre el uso de teléfonos móviles y SMS para realizar intervenciones de autogestión de las enfermedades crónicas.
MÉTODOS: Una revisión meta se llevó a cabo de las 11 revisiones sistemáticas (SR) que fueron identificados y recuperados después de una extensa búsqueda en bases de datos electrónicas para los años 2000-2012. La información pertinente se abstrae de cada revisión sistemática y una evaluación de la calidad lleva a cabo utilizando el ("Una herramienta de medición para evaluar Revisiones Sistemáticas") AMSTAR criterios.
RESULTADOS: El número y tipos de estudios incluidos y el número total de sujetos variaron significativamente entre las revisiones sistemáticas. Móvil mensajes de texto de teléfono se informó a mejorar significativamente la adherencia a las citas y la terapia antirretroviral, el fumar a corto plazo las tasas de abandono, y seleccionó los resultados clínicos y de comportamiento. Puntajes AMSTAR oscila entre un 11 a 3, lo que refleja una variación sustancial en la calidad de SR.
VINCULACIÓN DE LAS PRUEBAS A LA ACCIÓN: Los teléfonos móviles y el espectáculo SMS promesa como una tecnología para realizar intervenciones de autogestión para mejorar los resultados de la gestión de la atención crónica. Sin embargo, la calidad de los futuros estudios y revisiones sistemáticas necesita ser mejorado. También hay cuestiones sin resolver acerca de la tecnología en sí.
Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support.
METHODS:
From a search of eight databases (January 1993-October 2012; update June 2017) we included systematic syntheses of qualitative studies of patients' experiences, and systematic reviews of randomized controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used meta-ethnography, meta-Forest plots and narrative analysis to synthesise the data.
RESULTS:
Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced SBP (by between 2 and 6 mmHg), and DBP (by between 1 and 5 mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients' perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient-professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension.
CONCLUSION:
Our systematic qualitative and quantitative meta-reviews tell complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. HBPM (with or without telehealth) within the context of a supportive patient-professional partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.
