12/09/2025
Should we instruct patients to adjust their blood pressure medications on their own?
Our physician have been discussing practices that could decrease the burden of patients having to take time off of work and other other obligations for clinic visits. The goal is to maximize patient convenience while keeping them safe and well-treated.
We have identified some clinical practices to aid this end that are supported by research. One of these is self-diagnosis of UTIs. The data shows that most adult patients are able to correctly identify when they have a UTI. They don't need to come in to provide a urine sample as the diagnosis is quite reliable based on their symptoms. So usually when an adult patient contacts us reporting UTI symptoms, we can simply prescribe an antibiotic.
In our physician journal club this week we reviewed a study on having patients track their blood pressures at home and then follow home instructions from their physician to increase blood pressure medications based on their measurements. In the study they increased their blood pressure medication without returning to the clinic for further discussion with their physician. The approach is appealing because home blood pressures can be more accurate than those at the clinic. Many patients have higher blood pressures at the clinic because they are nervous to be here.
The study was performed in Spain and showed that blood pressure control was slightly better for patients who had home instructions compared to those had to return to the clinic for further instructions from their physician. However, the study also showed that low blood pressures, faints, and hospitalizations from medication issues were higher in the home-decision group.
We reflected that in our practice, we can communicate with ourpatients by phone, text, and email. We don't need to drag patients into the clinic for simple instructions. We concluded that with our easy communication, it is better to have direct communication about treatment changes than relying on pre-written algorithms. Treatment instruction without direct conversation can lead to confusion, dosing errors, and patient harm. Our communication does not have to happen with a clinic visit. It could happen with a phone call.
We do need to ensure that our patients have working blood pressure cuffs and know how to correctly check their blood pressure. (This could be done by practicing use of them in our office visits.) So we concluded- good on you, Spain! But we will continue to directly communicate with our patients for treatment changes.