In Bradford, West Yorkshire, a group of 14 practices from Bradford District CCG invited people who had a previous primary diagnosis of hypertension to use VitruCare. Individuals were able to use this digital service via their home computer to identify issues that were personally relevant and to build action plans that they felt would help them achieve their chosen goal. They could also select tracking tools to allow them to monitor their progress over time. In order to ensure that plans chosen were appropriate for their situation, clinical sign off was required before a person could begin working on their plan.
From a cohort of approximately 800, an audit review was undertaken using the SystmOne records of a subset of 144 patients, taken from 14 practices. Patients had been using VitruCare for between 9-12 months. A comparison was made between the initial and final values for weight, mean BP and where appropriate – in people with a co-morbidity of diabetes – HbA1c. In addition, for each patient the number of contacts with primary care was quantified (face to face and telephone contacts) for the period of VitruCare use and compared with an equivalent length of time immediately before starting to use the service.
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Data analysis was undertaken by Dr C Wilson, University of Salford. Although patients were not given any guidance regarding the type of Goal/Action Plan they should construct, most patients lost weight of average 2Kg over the period of VitruCare use. Their mean BP also fell by almost 6mm Hg and in a smaller set of people who also had diabetes, HbA1c values also fell by an average of 16mMol/Mol.
In addition to these clinically significant biomedical changes, contacts with primary care fell substantially, with an overall reduction of 55% in the total number of contacts during the period of VitruCare usage.
Review of the goals chosen by patients showed that in 95% of cases the goal was not overtly a ‘medical’ goal; life goals predominated. Although this was not a formal clinical study, it seems likely that the ability to set the agenda for one’s own care and to choose to work on short term, personally relevant (rather than population biomedical target driven) goals helps people with hypertension achieve concurrent improvements in outcome markers and reductions in contacts with primary care. If operating at scale, such a win:win could offer materially important benefits to population health and the health system itself.