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

ObjectiveTo estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only).DesignA parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement.Setting31 primary healthcare centers in Sweden.Subjects949 patients treated for hypertension.Main outcome measuresThe effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression.ResultsAt baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months.ConclusionThe interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care. Although patient participation is essential when having a long-term condition, interventions optimizing individuals' engagement have not been fully identified.About half of the patients with hypertension in this study did not experience participation in the manner and extent they preferred.A web-based support system via mobile phone improved some aspects of patient participation in the short- but not long term.Strategies to better identify patients' preferences for patient participation are needed, to evaluate and improve the outcome of care.