Why are doctors still measuring blood pressure?

A’Court, Christine; McManus, Richard J

doi:10.3399/bjgp14x677734

Cited by 3 publications

(2 citation statements)

References 16 publications

(15 reference statements)

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“…Therapeutic education requires time and resources they often do not have (as a reminder, the GPs interviewed were mostly installed alone or in areas of low medical density). GPs therefore do not give themselves the time or the means to form a shared medical decision and decide on their own what is good for their patients [57]. This paternalistic aspect did not appear in a similar British study.…”

Section: Discussionmentioning

confidence: 99%

Implementation of home blood pressure monitoring among French GPs: A long and winding road

et al. 2019

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BackgroundTo explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice.MethodsA qualitative study comprising the conduct of six focus groups between October 2016 and February 2017, gathering 41 general practitioners in primary care practice in Lorraine (North Eastern France), with thematic and comprehensive analysis.ResultsThe first reasons given by GPs to explain their difficulties with HBPM (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources. However, all of these motives masked other substantial limiting factors including insufficient knowledge regarding HBPM, poor adherence to recommendations on HBPM and fear of losing their medical authority. GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia. Despite this observation, most GPs used HBPM only at the time of diagnosis and rarely for follow-up. One explanation for GP reluctance towards HBPM may be, along with guidelines regarding hypertension, HBPM is perceived as being a binding framework and being difficult to implement. This barrier was more predominantly observed among aging GPs than in young GPs and was less frequent when GPs practiced in multidisciplinary health centers because the logistical barrier was no longer present.DiscussionIn order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. We must also end "medical power" in hypertension management and turn to multidisciplinary care including nurses, pharmacists and patients.

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Section: Discussionmentioning

confidence: 99%

Implementation of home blood pressure monitoring among French GPs: A long and winding road

et al. 2019

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“…9 Understanding of the factors that complicate interpretation of office BPs reinforces the case for selfmonitoring, at least in the management of hypertension. 10 Recommendations for home monitoring with clear instructions and a flexible schedule may be welcomed by patients.…”

Section: Implications For Organisation Of Carementioning

confidence: 99%

Blood pressure measurement: a call to arms

2016

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Our hard-pressed workforce may view the linked article by Clark and colleagues with a mixture of interest and trepidation.1 Their systematic review builds on earlier work to estimate the prevalence of inter-arm difference (IAD) in blood pressure (BP) in populations relevant to primary care. Pooled estimates of prevalence for systolic IAD of ≥10 mmHg were 11% in patients with hypertension, 7% for those with diabetes, and just under 4% in the general adult population.GPs are masters of distilling from their training and experience the shortest route to a clinical decision. This does not generally involve checking BP in both arms.1 Yet, paradoxically, this new evidence could reduce workload, because accurate identification of IAD in a minority of patients, and the exclusion of this condition in the majority, might inform a more rational and streamlined approach to blood pressure management in both groups. HOW SHOULD WE MEASURE IAD?Many studies investigating IAD have used sequential measurements, that is, using the same manometer in first one then the other arm. An important finding in Clark and colleagues' systematic review was that prevalence of IAD is overestimated threefold by sequential measurement compared with the repeated simultaneous blood pressure measurement protocol from which the headline prevalences were derived.

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Human Errors in Automated Office Blood Pressure Measurement

Elias

Goodell

2021

Hypertension

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In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to revisit issues as to the pros and cons of automated BP measurement published in Hypertension in June 2020 and to identify areas needing additional research. Despite initial reservations about automated BP, it is here to stay. A number of experts suggest that human error will be reduced when we move from the more complex skills required by aneroid sphygmomanometer measurement to the fewer skills and steps required by automated BP measurement. Our review indicates there is still need for reduction in errors in automated BP assessment, for example, retraining programs and monitoring of assessment procedures. We need more research on the following questions: (1) which classes of health care providers are least likely to measure BP accurately, usually by ignoring necessary steps; (2) how accurate is BP assessment by affiliated health care providers for example the dental office, the optometrist; and (3) why do some dedicated and well-informed health care professionals fail to follow simple directions for automated BP measurement? We offer additional solutions for improving automated BP assessment in the office and clinic.

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Why are doctors still measuring blood pressure?

Abstract: provenance Commissioned; not externally peer reviewed.

Cited by 3 publications

References 16 publications

Implementation of home blood pressure monitoring among French GPs: A long and winding road

Implementation of home blood pressure monitoring among French GPs: A long and winding road

Blood pressure measurement: a call to arms

Human Errors in Automated Office Blood Pressure Measurement

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