Measuring and Managing Blood Pressure in a Primary Care Setting: A Pragmatic Implementation Study

Journal of the American Board of Family Medicine: JABFM

Jenni Buu^1¹  John Doane^1² 

[1]Pharmacy Primary Care Services, University of Utah Health, Salt Lake City (JB)^1

[2]From the Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City,UT (JD, MJP, MB, MBC, BS)

关键词: Blood Pressure;    Hypertension;    Implementation Science;    Personal Satisfaction;    Primary Health Care;    Surveys and Questionnaires;   

DOI  :  10.3122/jabfm.2018.03.170450

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Accurate blood pressure (BP) measurement is essential to hypertension diagnosis and management. Automated office blood pressure (AOBP) and home blood pressure measurement (HBPM) may improve assessment, but barriers exist in primary care settings. Methods: We implemented an AOBP/HBPM program in a primary care clinic in 2015 to 2016. Patients with elevated BP determined by guideline-quality observed BP measurement and/or AOBP entered the HBPM program. Patients with average home BP ≥ 135/85 mm Hg provided HBPM results for medication adjustment. Clinic staff and patients completed satisfaction questionnaires. Results: Initial HBPM results in 183 patients with elevated office BP revealed white-coat BP elevation in 35% of untreated patients and in 37% of treated patients. The prevalence of white-coat BP elevation was similar whether enrollment BP was by observed BP or AOBP. Subsequent HBPM facilitated BP control in 49% of patients with elevated home BP. Most providers, staff, and patients endorsed the utility of the program. Barriers to implementation included a temporary period of incorrect AOBP technique, patients failing to provide HBPM results, and incorrect HBPM technique. Discussion: Our clinic-based AOBP/HBPM program detected white-coat BP elevation in one third of enrolled patients, facilitated control of home BP, and was acceptable to staff and patients. We identified barriers to be addressed to ensure sustainability.

【 授权许可】

CC BY