Primary care physician beliefs and practices regarding blood pressure measurement: results from BP-CHECK qualitative interviews

BMC Primary Care

Research

Matthew Thompson¹  Sean Munson²  Karen L. Margolis³  Kelly Ehrlich⁴  Laurel Hansell⁴  Melissa Anderson⁴  Dwayne Joseph⁴  Clarissa Hsu⁴  Jennifer B. McClure⁵  Beverly B. Green⁶  Yoshio N. Hall⁷ 

[1] Department of Family Medicine, University of Washington, Seattle, WA, USA;Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA;HealthPartners Institute, Minneapolis, MN, USA;Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, 98101, Seattle, WA, USA;Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, 98101, Seattle, WA, USA;Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA;Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, 98101, Seattle, WA, USA;Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA;Washington Permanente Medical Group, Seattle, WA, USA;Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA;

关键词: Blood pressure;    Diagnosis;    Measurement;    Provider attitudes;    Hypertension;    Kiosk;    Home;    Ambulatory;    Primary care;    Out-of-clinic;   

DOI  :  10.1186/s12875-022-01950-1

 received in 2022-02-25, accepted in 2022-12-20,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEarly identification and control of hypertension is critical to reducing cardiovascular disease events and death. U.S. Preventive Services Task Force guidelines recommend health care professionals screen all adults for hypertension, yet 1 in 4 adults with hypertension are unaware of their condition. This gap between guidelines and clinical practices highlights an important opportunity to improve blood pressure (BP) screening and hypertension diagnosis, including measurement outside of clinic settings. To identify targets for future diagnostic interventions, we sought to understand primary care physicians' (PCPs) beliefs and practices regarding use of common forms of BP measurement.MethodsStudy participants were PCPs (N = 27) who had patients enrolled in the BP-CHECK trial. The trial compared the accuracy of 24-h ambulatory BP monitoring (ABPM) to: 1) clinic-based monitoring, 2) home BP monitoring (HBPM), or 3) use of a BP kiosk in clinics or pharmacies. Physicians were interviewed by phone and compensated for their participation. Interviews were recorded, transcribed, and analyzed using a template analysis approach.ResultsOverall, PCPs preferred and trusted clinic BP measurement for diagnosing hypertension, particularly when measured with a manual sphygmomanometer. Concerns with HBPM included the belief that patients did not follow protocols for rest and body positioning at home, that home machines were not accurate, that home BPs could not be entered into the medical record, and that HBPM would make some patients anxious. Issues regarding kiosk measurement included beliefs that the public setting created stress for patients, that patients did not follow resting protocols when using kiosks, and concerns about the maintenance of these machines. ABPM was recognized as highly accurate but was not perceived as accessible. Additionally, some PCPs found it challenging to interpret the multiple readings generated by ABPM and HBPM, especially when these readings differed from clinic BPs.ConclusionsOur findings suggest that both additional physician education and training and investments in equipment and system-level processes are needed to increase the acceptance and utilization of out of office BP measurement for identification and treatment of hypertension. These changes are needed to improve ensure everyone in the U.S receive optimal care for hypertension.Trial registrationClinicalTrials.gov NCT03130257. Initial registration date: 4/21/2017.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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