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

Doane, John; Buu, Jenni; Penrod, M. Jason; Bischoff, Michelle; Conroy, Molly B.; Stults, Barry M.

doi:10.3122/jabfm.2018.03.170450

Cited by 19 publications

(20 citation statements)

References 52 publications

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“…Projected procedure times incorporating a 5‐minute delay would be 8.94, 8.79, and 8.58 minutes. The narrower range for AOBP procedure time noted in University Clinic 1 may result from their prior participation in a formal implementation study of u‐AOBP as well as workflow issues related to the larger number of MAs and clinicians in the other two clinics.…”

Section: Resultsmentioning

confidence: 99%

“…Arguments against using u‐AOBP have included a lack of data about the cardiovascular prognostic significance of u‐AOBP and a perception that u‐AOBP may not be time‐efficient and feasible in clinical practice . While recent studies demonstrate strong associations of u‐AOBP with cardiovascular events and subclinical organ damage, few studies have investigated the practicality of u‐AOBP in primary care . We conducted a time efficiency study in three primary care clinics to measure u‐AOBP procedure time, medical assistant (MA) clinical activities during u‐AOBP performance, and MA and clinician satisfaction with and knowledge about u‐AOBP performance and interpretation.…”

Section: Introductionmentioning

confidence: 99%

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Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Doane

Flynn

Archibald

et al. 2020

J of Clinical Hypertension

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Because of the 15%-30% prevalences of white-coat blood pressure (BP) elevation 1 and masked hypertension, 2 out-of-office BP measurement is recommended to confirm the diagnosis of hypertension for most patients using either 24-hour ambulatory or home BP monitoring. [3][4][5][6][7][8] Still, accurate office BP measurement (OBPM) remains essential to limit the need for labor-intensive and expensive out-of-office BP monitoring. Unfortunately, OBPM in routine clinical practice is often performed inaccurately due to incorrect patient preparation and manual auscultatory measurement technique. 9,10 To improve OBPM accuracy, current guidelines recommend validated, automatic oscillometric devices to replace manual auscultatory BP measurement. 3-7 But guideline-recommended OBPM with these devices does not eliminate white-coat BP elevation. 10,11 In contrast, validated, automated oscillometric devices that automatically perform and average three to five BP measurements over 3-5 minutes while the patient rests alone in the exam room or another quiet place have been demonstrated to substantially reduce white-coat BP elevation. 12,13 This approach to OBPM, termed unattended automated office BP measurement (u-AOBP), is recommended as the preferred OBPM technique for patients with an initial elevated observed BP measurement by the Abstract Unattended automated office blood pressure (BP) measurement (u-AOBP) improves office BP measurement accuracy and reduces white-coat BP elevation, but there are reservations about its time efficiency in primary care. We used time-stamp methodology to measure u-AOBP procedure times performed without a rest period in 130 patients during routine clinic visits to three primary care clinics with 2.5-4.9 years u-AOBP experience. We documented the clinical activities of 30 medical assistants during the u-AOBP procedures. We also assessed MA and clinician satisfaction and knowledge about u-AOBP performance and interpretation. Median u-AOBP procedure time was <5 minutes, and MAs engaged in productive clinical activities during 83% of the procedures. Ninety-three percent of MAs and 100% of clinicians in the clinics agreed that u-AOBP is an efficient method to improve hypertension management. Barriers to effective u-AOBP implementation and ongoing utilization included initial difficulty incorporating u-AOBP into clinic workflow and medical staff knowledge deficiencies concerning correct u-AOBP performance and interpretation despite prior training and experience with the procedure. Intensive u-AOBP education and training programs are needed to facilitate effective u-AOBP implementation into primary care. The time required to perform u-AOBP can be utilized productively by staff.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Doane

Flynn

Archibald

et al. 2020

J of Clinical Hypertension

Self Cite

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“…Canada study showed that only 8% of patients with hypertension were trained with the home blood pressure monitoring (HBPM) technique ( 17 ). Another American study with the HBPM program found that 13% of patients were sufficiently compliant with BP measurement guidelines to ensure reliable readings ( 18 ). Similarly, one Chinese cross-sectional survey collected data among 2,272 patients with hypertension aged ≥35 years from 20 communities across three cities and six townships in three provinces and found that only 45.3% owned a home blood pressure (BP) monitor.…”

Section: Discussionmentioning

confidence: 99%

Risk Prediction Model for Uncontrolled Hypertension in Chinese Community

Gao

Chen

Huang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundUncontrolled hypertension rate was still high across China. This study develops and validates an index to help quantify the combination of socio-behavioral aspects to screen high-risk patients in uncontrolled hypertension in Chinese primary care.MethodsA cross-sectional study included 1,039 of patients with hypertension in the Chinese community. We assessed independent risk factors of uncontrolled blood pressure (defined as having a blood pressure ≥140/90 mmHg, even with antihypertensive therapy) and develop a risk prediction model.ResultsAmong the 1,039 patients (53.9% male, the average age was 61 ± 13 years), 452 (43.5%) were uncontrolled hypertensive. Multivariable analysis showed that worker (odds ratio, OR: 1.98, 95% CI: 1.46–2.69), no health insurance (OR: 3.47, 95% CI: 2.08–5.80), non-marital status (OR: 2.01, 95% CI: 1.35–3.27), and other socio-behavioral aspects were independent risk factors of uncontrolled hypertension, which were included the final prediction model (C-static: 0.781). With internal validation by the bootstrap method, the risk score showed good discriminating ability and predicting ability for the incidence of uncontrolled hypertension (C-static: 0.771).ConclusionsThis study showed that nearly half of the patients suffered from uncontrolled hypertension in the Chinese community. We established a prediction model with good predictability to help quantify the combination of socio-behavioral aspects and screen high-risk patients with uncontrolled hypertension.

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“…Similarly, despite excellent evidence and guidelines, actual hypertension diagnosis and management is often complicated by "white-coat" blood pressure elevation during office visits. Doane et al 26 describe a pragmatic approach, which trained patients in home blood pressure measurement that resulted in adequate blood pressure control in half of nearly 200 patients with clinic-identified white-coat hypertension. The approach is inexpensive and acceptable to both providers and patients.…”

Section: Preventing and Addressing Chronic Disease In Primary Care Prmentioning

confidence: 99%

Advancing the Science of Implementation in Primary Health Care

Bazemore¹,

Neale²,

Lupo³

et al. 2018

J Am Board Fam Med

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Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM, investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care. (J Am Board Fam Med 2018;31:307-311.)It is commonly estimated that evidence-based interventions require an average of 17 years to be incorporated into routine practice.1,2 Increasing payer and delivery system interest in narrowing that time gap has rapidly elevated the field of Implementation Science; the study of how evidence-based practice and policy can be effectively communicated, deployed, and brought to scale. Effective and efficient implementation is of particular importance in primary care, which is both the largest delivery platform and niche in the US health care ecology and an area largely neglected in the landscape of health care spending and biomedical research. 3,4 This theme issue of JABFM highlights lessons from, and efforts to advance implementation science in primary care.

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

Cited by 19 publications

References 52 publications

Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Risk Prediction Model for Uncontrolled Hypertension in Chinese Community

Advancing the Science of Implementation in Primary Health Care

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