Brian Hubert Mckinstry

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• MBChB MD FRCPE FRCGP
• Professor at University of Edinburgh

Background Blood pressure (BP) control following stroke is important but currently sub-optimal. This trial aimed to determine whether self-monitoring of hypertension with telemonitoring and a treatment escalation protocol, results in lower BP than usual care in people with previous stroke or transient ischaemic attack (TIA). Methods Unblinded rand...

Background Hypertension is a key risk factor for death and disability, and blood pressure reduction is associated with significant reductions in cardiovascular risk. Large trials have shown that interventions including self-monitoring of blood pressure can reduce blood pressure but real-world data from wider implementation are lacking. Aim The sel...

Introduction There is growing research interest in applying Artificial Intelligence (AI) methods to medicine and healthcare. Analysis of communication in healthcare has become a target for AI research, particularly in the field of analysis of medical consultations, an area that so far has been dominated by manual rating using measures. This opens n...

There is uncertainty about how best to diagnose asthma, especially in primary care where mis-diagnosis is common. To address this, we developed a clinical decision support system (CDSS) for asthma diagnosis in children and young people (aged 5-25 years). This study explored the feasibility and acceptability of the CDSS in UK primary care. We recrui...

Objectives The aim of this study was to understand how patients experienced hypertension management, with or without blood pressure (BP) telemonitoring, during the COVID-19 pandemic. Design, methods, participants and setting This qualitative study conducted between April and November 2022 consisted of 43 semistructured telephone interviews (23 men...

Objective: Asthma can be difficult to diagnose in primary care. Clinical decision support systems (CDSS) can assist clinicians when making diagnostic decisions, but the perspectives of intended users need to be incorporated into the software if the CDSS is to be clinically useful. Therefore, we aimed to understand health professional views on the...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office Background Atrial fibrillation (AF) related stroke risk can be reduced with oral anticoagulants (OACs). OACs need to be taken once or twice a day to maintain effectiveness but non-adherence remains a challenge mH...

In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID –19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultation...

Background A connected system with smart devices could transform patient care and empower patients control of their asthma. Objective To explore how a connected-for-asthma system (C4A) with smart devices from multiple companies (smart-inhaler; smart-watch; smart-peak-flow meter, manual digital thermometer during the Coronavirus disease (COVID)-pan...

Introduction Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. Methods Participants diagnosed with ast...

The COVID19 pandemic highlighted the need for remote diagnosis of cognitive impairment and dementia. Telephone screening for dementia may facilitate prompt diagnosis and optimisation of care. However, it is not clear how accurate telephone screening tools are compared with face-to-face screening. We searched Cochrane, MEDLINE, Embase, Web of Scienc...

Mixed methods implementation study of a structured sleep medicine review template.

BACKGROUND Although mobile health (mHealth) applications are increasingly being used to support patients with multiple chronic conditions (multimorbidity), the majority of mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, it is important to understand social-behavioral factors that impact patients’ u...

Background Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors th...

Background Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and we...

Background Recruiting participants to a clinical study is a resource-intensive process with a high failure rate. The Scottish Health Research Register (SHARE) provides recruitment support service which helps researchers recruit participants by searching patients’ Electronic Health Records (EHRs). The current study aims to evaluate the performance o...

Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumon...

Background Mobile health applications are increasingly used to support the delivery of health care services to a variety of patients. Based on data obtained from a pragmatic trial of the electronic Patient Reported Outcome (ePRO) app designed to support goal-oriented care primary care, this study aims to (1) examine how patient-reported usability c...

Background Recruiting participants to a clinical study is a resource-intensive process and has high rate of failure. The Scottish Health Research Register (SHARE) provides recruitment support service which helps researchers recruit participants by searching patients’ Electronic Health Records (EHRs). The current study aims to evaluate the performan...

Objective Systematic reviews estimate the prevalence of hypertension in high income countries to be 28.5%, with 55.6% of hypertensives on treatment and 28.4% of those on treatment having controlled hypertension. We used these estimates to determine the proportion of untreated hypertensives in the Greater Glasgow and Clyde population and to evaluate...

Background: Chronic respiratory diseases (CRD), are common public health problems with high prevalence, disability and mortality rates worldwide. Further uneven distribution of the health workforce is a major barrier to the effective diagnosis and treatment of CRDs. Teleconsultation between a specialist and non-specialist could possibly bridge the...

BACKGROUND Goal-oriented care is being adopted to deliver person-centred primary care to older adults with multimorbidity and complex care needs. While this model holds promise, implementation remains a challenge. Digital health solutions may enable processes to improve adoption, however, they require evaluation to determine feasibility and impact....

Background Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and...

Background: Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic...

Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from f...

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may em...

Background: Children in lower middle-income countries (LMICs) are more at risk of dying, than those in High Income Countries (HICs), due to highly prevalent deadly yet preventable childhood infections. Alongside concerns about the incidence of these infections, there has been a renewed interest in involving community health workers (CHWs) in vario...

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to...

BACKGROUND Internet-of-things (IoT) systems with artificial intelligence can provide customised support for a range of self-management functions, but trust is vital to encourage patients to adopt such systems. OBJECTIVE We aimed to explore patients/clinicians’ trust in IoT systems in the context of asthma self-management (including emergency advic...

Background: Asthma affects 235 million people worldwide. Supported self-management, including an action plan agreed with clinicians, improves asthma outcomes. Internet-of-things (IoT) systems with artificial intelligence (AI) can provide customized support for a range of self-management functions, but trust is vital to encourage patients' adoption...

Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic an...

Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic an...

Introduction Pneumonia contributes to 14% of under-five mortality in Pakistan. Delayed care seeking is one of the causes of death due to this disease. One of the most impactful strategies can be timely healthcare-seeking through CHW's. We, therefore propose to develop an intervention package for educating caregivers on pneumonia by Lady Health Work...

BACKGROUND Supported self-management for asthma reduces acute attacks and improves control. The Internet-of-Things (IoT) could connect patients to their healthcare providers, the community services and their living environment to provide over-arching support for self-management. OBJECTIVE We aimed to identify patients’ and clinicians’ preferences...

Background Supported self-management for asthma reduces acute attacks and improves control. The internet of things could connect patients to health care providers, community services, and their living environments to provide overarching support for self-management. Objective We aimed to identify patients’ and clinicians’ preferences for a future in...

Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly and some may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective:...

Background While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings wil...

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferre...

Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is t...

Background: Behaviour change interventions targeting physical activity, diet, sleep and sedentary behaviour of teenagers show promise when delivered through smartphones. However, to date there is no evidence of effectiveness of multicomponent smartphone-based interventions. Utilising a user-centred design approach, we developed a theory-based, mul...

Background: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. Methods: A systematic review was conducte...

To the Editor: Denny and colleagues (Aug. 15 issue)¹ describe the progress of the All of Us Research Program. In Scotland, which has a population of 5.43 million, a patient registry² is achieving some of the advantages envisaged by All of Us. The Scottish Health Research Register (SHARE) began accessing data from electronic health records (EHRs) in...

Background: Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice. Aim: To explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice. Design and setting: Comparison of audio-r...

Background: People increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode. Aim: To explore patients' and clinicians' experiences of VC. De...

Background 1.2 million appointments in Scottish primary care annually are used solely for checking blood pressure (BP). While evidence from randomised controlled trials (RCTs) shows that telemonitoring of BP produces significant reductions, it has not been mainstreamed because of difficulties in integrating telemonitoring with routine medical care....

Background: Ready access to reliable data is essential to support decision-making in patient care planning and delivery. Health information exchange (HIE), which is fundamental to achieve this, is currently limited in many low- and middle-income countries (LMICs), reflecting the lack of prioritization of this issue and the many barriers to its succ...

Study protocol for the use of a structured sleep medicine clinical review template in clinical practice - A mixed methods implementation study.

BACKGROUND Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to...

BACKGROUND Home blood pressure monitoring (HBPM) is one component of effective supported self-management which may potentially be mediated by mobile apps. OBJECTIVE We aimed to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated with download frequ...

Background Home blood pressure monitoring (HBPM) is one component of effective supported self-management, which may potentially be mediated by mobile apps. Objective The aim of this study was to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated wi...

The integration of patient/person generated health data into clinical applications is a widespread aspiration internationally. However, there is still a range of challenges that inhibit progress in this area. These include technology-related factors (such as interoperability), use-related factors (such as data overload) and characteristics of the s...

Introduction Due to the many advantages of open source software (OSS), including reduced cost of licensing, more flexibility in terms of customisation and redistribution, better quality and no vendor lock-in, OSS in healthcare is increasingly gaining importance. Various open source health information technologies (OS-HITs) are continuously being de...

Background Apps can potentially support asthma self-management; however, attracting downloads and encouraging on-going adherence are challenging. Objectives We observed the impact of different recruitment strategies and app features on adoption and continued use. Methods Practice nurses in five practices in Lothian/Oxford approached adults with a...

Background: Telemonitoring for long term conditions such as hypertension and diabetes has not been widely adopted despite evidence of efficacy in trials and policy support. The Telescot programme comprised a series of seven trials and observational studies of telemonitoring for long term conditions in primary care, all with an explanatory qualitat...

Supplementary information: figures 1-3, extended methods, tables 1-8, statistical analysis plan, and references

Objective To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice. Design Prospective observational cohort study. Setting 10 primary care practices and one hospital in the UK. Parti...

Objective: To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice. Design: Prospective observational cohort study. Setting: 10 primary care practices and one hospital in the UK....

Background: The receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments. Aim: The authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care. Design and setting: The authors conducted a team-based focuse...

Background There is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood...

Objectives To establish the feasibility of the Digital Support Platform (DSP), an internet-based, postdiagnostic tool designed for families living with a diagnosis of dementia. Design Qualitative methods using normalisation process theory as an analysis framework for semistructured interview transcriptions. Setting A community care setting in the...

Objective Simple forms of blood pressure (BP) telemonitoring require patients to text readings to central servers creating an opportunity for both entry error and manipulation. We wished to determine if there was an apparent preference for particular end digits and entries which were just below target BPs which might suggest evidence of data manipu...

Background: NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioner...

Clinical guidelines in the United States and United Kingdom recommend that individuals with suspected hypertension should have ambulatory blood pressure (BP) monitoring to confirm the diagnosis. This approach reduces misdiagnosis because of white coat hypertension but will not identify people with masked hypertension who may benefit from treatment....

Clinical guidelines in the US and UK recommend that individuals with suspected hypertension should have ambulatory blood pressure (BP) monitoring (ABPM) to confirm the diagnosis. This approach reduces misdiagnosis due to white coat hypertension but will not identify people with masked hypertension who may benefit from treatment. The Predicting Out-...

Focused ethnography is an applied and pragmatic form of ethnography that explores a specific social phenomenon as it occurs in everyday life. Based on the literature a problem-focused research question is formulated before the data collection. The data generation process targets key informants and situations so that relevant results on the pre-defi...

Background: Telemonitoring of symptoms and physiological signs has been suggested as a means of early detection of chronic obstructive pulmonary disease (COPD) exacerbations, with a view to instituting timely treatment. However, algorithms to identify exacerbations result in frequent false-positive results and increased workload. Machine learning,...

Information technology (IT) in healthcare, also referred to as eHealth technologies, may offer a promising solution to the provision of better care and support for people who have multiple conditions and complex care needs, and their caregivers. eHealth technologies can include electronic medical records, telemonitoring systems and web-based portal...

Introduction: Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-f...

Background The implementation of telemonitoring at scale has been less successful than anticipated, often hindered by clinicians’ perceived increase in workload. One important factor has been the lack of integration of patient generated data (PGD) with the electronic medical record (EMR). Clinicians have had problems accessing PGD on telehealth sys...

Policy makers should reconsider their unequivocal support for these systems

Background Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension....

Levels of self-monitoring intervention. Levels used to describe the included self-monitoring interventions. * 1:1 contact or support in this context refers to contact over and above that in usual care. Abbreviation: BP, blood pressure. (DOCX)

The protocol paper published by the BMJ Open (available at http://bmjopen.bmj.com/content/bmjopen/5/9/e008532.full.pdf). (PDF)