Journal Club #5 – Tuesday 19th March 2019, 20:00 GMT.
Chair: Cini Bhanu @cinibhanu
Cini is an ST4 Academic Clinical Fellow in General Practice based at the Primary Care & Population Health department at UCL and a GP practice in Islington. She has an interest in ageing and has been involved in mixed-methods research on dementia health inequalities, nutrition and depression in later life. She has a particular interest in complex polypharmacy and the use of large primary care datasets to better understand this. Alongside her ACF projects, she is doing a Masters in Public Health Research and enjoys exploring the role of the arts in health & wellbeing.
As we move into an era where there is an increasing need for clinical trials to evidence different models of care - particularly in General Practice where 90% of NHS patient contact takes place – what methodological and wider questions does this raise? And what questions should we be asking of randomized controlled trials (RCTs) on interventions looking at shared-care with patients and technology?
To consider just this, in this journal club we looked at an important primary care paper: “Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial”, published in the Lancet (@TheLancet) in 2018. The paper is open access and can be downloaded here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30309-X/fulltext
This unmasked randomised controlled trial conducted in 142 GP practices looks at self-monitoring BP, with and without telemonitoring vs. usual care, on hypertension control.
We considered whether this paper raises any different questions, compared to a traditional RCT on a drug vs. placebo? Can we ensure quality control? Do wider issues around patient recruitment matter more in studies looking at patient-led self-monitoring?
Will this paper change clinical practice, service provision and workloads?