Authors: (including presenting author): :
Pong KWC (1), Lam SHC (1), Fung YSE (1), Cheung TYJ (1), Chan ML (2), Chan YHE (2), Cheng SYR (2), Liang J (2)
Affiliation: :
(1) Occupational Therapy Department, Tuen Mun Hospital, NTWC (2) Department of Family Medicine and Primary Health Care, NTWC
Introduction: :
White-coat hypertension (WCHT) or hypertension (HT) with white-coat effect (WCE) is commonly encountered in primary care setting with 15-30% prevalence in the general population. Patients with WCHT or WCE have higher blood pressure and anxiety in clinic. Ambulatory Blood Pressure Monitoring (ABPM) is a gold standard investigation to confirm the diagnosis. However, related therapeutic intervention is uncommon in General Out-patient Clinic (GOPC). Occupational Therapist with expertise in individual or group based lifestyle redesign intervention pioneered the “Fear-Less” Occupational Therapy Programme for patients with WCHT or WCE in New Territories West Cluster (NTWC).
Objectives: :
The “Fear-Less” Occupational Therapy programme aims to empower the patients with WCHT or WCE to handle their anxiety in clinic, reduce the risks of HT and promote better self-management for chronic disease.
Methodology: :
352 patients with confirmed or suspected WCHT or WCE were recruited from GOPCs in NTWC from April 2017 to January 2020. The “Fear-Less” programme included two therapeutic group sessions on understanding WCHT or WCE, stress management in clinic, mind-body relaxation practice and lifestyle modification, supplemented with home programme, individual consultation at two-month and follow up session at six-month.
Result & Outcome: :
Amongst the 352 subjects recruited, the mean age was 62.0 years (range 32-86, SD 8.4) with a female to male ratio of 4:1. Two-third of the subjects were prescribed with anti-HT medication. About half (53.7%) undergone ABPM to confirm the diagnosis, while 41.5% was suspected for WCHT or WCE by comparison with home BP monitoring. 288 cases completed two group sessions. The mean clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significantly lowered by 5.4%*** and 2.4%*** respectively while clinic heart rate (HR) decreased 6.3%**. 196 cases attended the two-month individual follow up. Comparing with intake, the mean clinic SBP and DBP significantly decreased 6.4%*** and 3.9%***. Clinic HR dropped 7.3% though not statistically significant. Generalized Anxiety Disorder(GAD)-7 Scale total score decreased from 5.1 to 3.9*** (cut off at 5 for mild anxiety symptom). In self-rated 10-point scales, subjective anxiety level in clinic decreased 18.6%***, both self-efficacy to HT self-management and sleep quality improved 11.7%*** and 8.8%***. 105 cases completed the programme and showed sustained effect at six-month review. While clinic SBP and DBP kept significant decrease of 5.7%*** and 5.3%**, GAD-7 Scale total score was 3.0*** with subjective anxiety level in clinic dropped 16.7%***, self-efficacy to HT and sleep quality kept 11.5%** and 10.3%* improvement when compared to intake (***p< 0.001, **p< 0.01, *p< 0.05). The results provide evidence for Occupational Therapy interventions to improve the clinic BP, subjective anxiety level in clinic and HT self-management among patients with WCHT or WCE, making them “Fear-Less” to the condition and have better self-management for chronic disease.
