Table 1

Use of the TECH model to design the Healthlines telehealth intervention for patients with raised cardiovascular risk

Model elementStrategies included in intervention
Engagement
 PatientHealthlines advisors provide simple welcome pack and technical support to overcome lack of confidence in technology
Encourage sense of personal care through seeking to maximise continuity of care from one named Healthlines advisor
 Health professionalAll communications seek to reinforce message that the Healthlines Service is supporting and delivered alongside primary care
Messages to primary care emphasise evidence-based nature of interventions and guidance
Promoting self-management
 Behaviour change techniquesHealthlines cardiovascular intervention adapted from the Duke self-management package,64 which uses scripts for advisors based on psychological principles of behaviour change. Intervention is tailored to patient's needs and goals
 Self-monitoring and feedbackProvide patients with free BP monitors and website to log readings which gives immediate feedback and graphical display about whether BP is above or below target (see online supplementary appendices 2 and 3)
 Provide patient informationHealthlines advisor works with patients to identify goals and then emails them links to further resources available on the internet, which have been quality assessed (eg, diet advice, risk calculators, videos, patient forums)
Treatment optimisation
 Risk stratificationCalculate cardiovascular risk. Level of intervention guided by level of risk factor with escalation to GP for patients at high risk
 Treatment intensificationMonthly review of BP using online log of BP readings, protocol driven advice to GP to intensify treatment each month if targets not met
 Promote medication adherenceMonthly review of medication adherence, scripts use evidence-based strategies to improve adherence, GPs advised by email if patients appeared to be non-adherent
Care coordination
 Shared recordsAll treatment recommendations shared with both primary care provider and patient. A summary of recent BP records from patient web portal is sent to GP when treatment change is recommended
 Regular monitoring of system performanceReporting module which allows monitoring of management programme (eg, of number of patients who have been telephoned, number actively self-monitoring BP)
Partnership
 All communications are shared between Healthlines, GP and patient. Communication is two way: GPs can contact Healthlines, for example, to change a patient's BP target
GPs and service managers involved in designing the Healthlines intervention
Context
Not all patients in UK have access to reliable internet connections. It is important to describe the characteristics of patients who take part, for evaluation
  • BP, blood pressure; GP, general practitioner.