Use of unattended automated office blood pressure in Utah primary care clinics

Abstract

Aim Unattended automated office blood pressure (BP) measurement (u-AOBP) improves office BP measurement accuracy and reduces white-coat BP elevation. u-AOBP is recommended as the preferred office BP measurement technique by multiple hypertension guidelines. This study examines utilization, performance, and potential barriers to implementation of u-AOBP in Utah primary care clinics following 5 years of promotional efforts by the Utah Million Hearts Coalition (UMHC). Methods An online questionnaire was administered to 285 Utah primary care clinics to evaluate self-reported use of u-AOBP and u-AOBP technique, interpretation of results, and perceived barriers to implementation. Results Seventy-nine of 285 clinics (27.7%) completed the full questionnaire. Fifty-nine clinics (74.7%) use u-AOBP. Nearly 65% first learned about u-AOBP through UMHC promotional efforts rather than from the medical literature. One-half of these clinics noted no significant barriers to u-AOBP implementation, and over 80% noted no reduction in medical staff productivity. However, important knowledge deficits concerning correct u-AOBP performance and interpretation of results were apparent from answers to the questionnaire. Conclusion After 5 years of UMHC promotional efforts, at least 20% of the 285 Utah primary care clinics invited to take the questionnaire and 75% of the 79 clinics completing the survey have incorporated u-AOBP and found it feasible in a primary care setting. Ongoing promotion of u-AOBP implementation at the local and regional level is required to extend its utilization. Effective, accessible educational materials and local technical assistance from public health and community partners are needed to correct knowledge and performance deficits to optimize u-AOBP utilization in primary care.

Conventional office blood pressure measurements and unattended automated office blood pressure compared with home self-measurement and 24-h ambulatory blood pressure monitoring

“…The possibility of finding an office BP measurement method providing information similar to out-to-office BP measurements is very attractive, which has led to the publication of multiple studies comparing AOBP with other methods available in the clinic [16–18,21]. Many of these studies have shown that the BP obtained by AOBP is lower than that obtained by conventional measurements and like that obtained by HSBP or ABPM [16,27,28].…”

“…The possibility of finding an office BP measurement method providing information similar to out-to-office BP measurements is very attractive, which has led to the publication of multiple studies comparing AOBP with other methods available in the clinic [16][17][18]21].…”

“…For this reason, AOBP has been suggested as a better method than the auscultatory technique because it has shown similar average BP readings as out-to-office methods using ABPM or HSBP [8,[16][17][18][19][20]. However, it has not yet had the preliminary expected diffusion, and there is also some reluctance to implement it [21][22][23]. The aim of the present study was to compare BP values obtained using four techniques: the conventional auscultatory mercury sphygmomanometer method, AOBP, HSBP, and ABPM.…”