The use of ambulatory blood pressure monitoring to confirm a diagnosis of high blood pressure by primary-care physicians in Oregon

Carter, Brittany U.; Kaylor, Mary Beth

doi:10.1097/mbp.0000000000000166

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…In fact, 80% of a small sample of 143 primary care physicians in a large urban city (Portland, Oregon) reported access to ABPM, although fewer than half reported using it. 21 The accuracy of HBPM performed in realworld settings is of concern. Recent studies indicate that only 10% to 17% of clinicians provide HBPM training that is even minimally adherent to guidelines for accurate measurement, [22][23][24] and fewer than 20% of patients may be sufficiently adherent to the recommended HBPM technique to ensure reliable HBPM.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

et al. 2017

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Purpose: This descriptive study examines hypertension diagnostic practices in Utah primary care clinics relative to the 2015 US Preventive Services Task Force (USPSTF) recommendations for the accurate diagnosis of hypertension. We assessed clinic procedures in place to facilitate accurate in-office and outof-office blood pressure (BP) measurement.Methods: An online questionnaire was administered to 321 primary care clinics. We compared current clinic BP measurement practices with the USPTF recommendations and assessed the level of adherence to the recommendations by level of clinic integration with a hospital.Results: Of the 321 primary care clinics that received the assessment, 123 (38.3%) completed the questionnaire. Clinics varied significantly in their ability to provide accurate in-office measurement, ranging from 57.5% to 93.5% of clinics complying with USPSTF recommendations. Only 25.2% of clinics reported having access to ambulatory monitoring and 36.6% had instructional materials for accurate home BP monitoring. Clinics integrated with a hospital were more likely to report adherence to recommendations than solo or independent clinics (36.4% vs 10.5%; P < .01).Conclusion :

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Section: Discussionmentioning

confidence: 99%

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

et al. 2017

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“…One study found that only 16% of MAs self-reported that they wait the recommended 5 minutes each time they measured BP. 16 Providing patients with specific instructions to rest or being able to set kiosk timing might help busy practices adhere to guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network

et al. 2016

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Background Using a self-service kiosk to measure blood pressure (BP) has the potential to increase patients’ awareness of their BP control and free up medical assistant (MA) time. The objective of this study was to evaluate BP kiosk acceptability and usability, as well as its effects on the workflow of patient BP self-measurement in a primary care clinic. Methods We used qualitative and quantitative assessments of kiosk implementation via meetings with clinic leaders, focus groups with clinic providers and staff, observations of kiosk users, and surveys of kiosk users at 2 and 8 months. Results Most patients were comfortable using the kiosk (82% at 2 months, 87% at 8 months). Initial provider concerns included accuracy, but most gained confidence after comparing it with other monitors and reviewing the literature supporting its accuracy. Patients and providers saw many benefits: easier BP checks, increased patient engagement, and saved MA time for other tasks. The clinic addressed early concerns (eg, infection control, confusing instructions, perceived loss of personal touch). Most patients (86%) supported the clinic continuing to use the kiosks. Conclusions Providers, staff, and patients adapted to the use of BP kiosks, providing value by engaging patients in their own care and saving MA time. The clinic decided to keep the self-service kiosk after the pilot period.

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“…22 Ambulatory BP monitoring is currently not broadly available, performed, or adequately reimbursed. [36][37][38] We acknowledge that increasing the number of clinic-and EHRrelated tasks, such as collecting, calculating, and documenting average home BP in the EHR, with no increase in the time allotted for patient visits will contribute to increased time pressure for physicians because hypertension is rarely the only reason for a clinic visit. 39,40 There are several concerns regarding the use of home BP measurement that might preclude its use for hypertension metrics.…”

Section: Discussionmentioning

confidence: 99%

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

et al. 2020

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PURPOSE Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. METHODS We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. RESULTS Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels. CONCLUSIONS Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.

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The use of ambulatory blood pressure monitoring to confirm a diagnosis of high blood pressure by primary-care physicians in Oregon

Abstract: Many primary-care physicians will need to change their current clinical practice to align with the shift toward a confirmation process for office-based hypertension diagnoses to improve population health.

Cited by 11 publications

References 38 publications

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

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