Mejzner Natasha, Clark Christopher E, Smith Lindsay Fp, Campbell John L
Primary Care Research Group, University of Exeter Medical School, Exeter, Devon.
East Somerset Research Consortium, Westlake Surgery, Yeovil, Somerset.
Br J Gen Pract. 2017 May;67(658):e306-e313. doi: 10.3399/bjgp17X690461. Epub 2017 Mar 27.
Previous surveys identified a shift to nurse-led care in hypertension in 2010. In 2011 the National Institute for Health and Care Excellence (NICE) recommended ambulatory (ABPM) or home (HBPM) blood pressure (BP) monitoring for diagnosis of hypertension.
To survey the organisation of hypertension care in 2016 to identify changes, and to assess uptake of NICE diagnostic guidelines.
Questionnaires were distributed to all 305 general practices in South West England.
Responses were compared with previous rounds (2007 and 2010). Data from the 2015 Quality and Outcomes Framework (QOF) were used to compare responders with non-responders, and to explore associations of care organisation with QOF achievement.
One-hundred-and-seventeen practices (38%) responded. Responders had larger list sizes and greater achievement of the QOF target BP ≤150/90 mmHg. Healthcare assistants (HCAs) now monitor BP in 70% of practices, compared with 37% in 2010 and 19% in 2007 (<0.001). Nurse prescribers alter BP medication in 26% of practices (11% in 2010, none in 2007; <0.001). Of the practices, 89% have access to ABPM, but only 71% report confidence in interpreting results. Also, 87% offer HBPM, with 93% of these confident in interpreting results.
In primary care BP monitoring has devolved from GPs and nurses to HCAs. One in 10 practices are not implementing NICE guidelines on ABPM and HBPM for diagnosis of hypertension. Most practices express confidence interpreting HBPM results but less so with ABPM. The need for education and quality assurance for allied health professionals is highlighted, and for training in ABPM interpretation for GPs.
以往的调查显示，2010年高血压护理已转向由护士主导。2011年，英国国家卫生与临床优化研究所（NICE）建议采用动态血压监测（ABPM）或家庭血压监测（HBPM）来诊断高血压。
调查2016年高血压护理的组织情况，以确定变化，并评估NICE诊断指南的采用情况。
向英格兰西南部的所有305家全科诊所发放问卷。
将回复与前几轮（2007年和2010年）进行比较。利用2015年质量与结果框架（QOF）的数据，比较回复者与未回复者，并探讨护理组织与QOF达标情况之间的关联。
117家诊所（38%）做出了回复。回复者的患者名单更长，且在实现QOF目标血压≤150/90 mmHg方面表现更佳。现在，70%的诊所由医疗保健助理（HCA）监测血压，而2010年为37%，2007年为19%（<0.001）。26%的诊所由护士开处方调整血压药物（2010年为11%，2007年无；<0.001）。在这些诊所中，89%可以进行ABPM，但只有71%表示有信心解读结果。此外，87%提供HBPM，其中93%有信心解读结果。
在初级护理中，血压监测已从全科医生和护士下放至医疗保健助理。十分之一的诊所未实施NICE关于采用ABPM和HBPM诊断高血压的指南。大多数诊所表示有信心解读HBPM结果，但对ABPM结果的信心较低。强调了对专职医疗人员进行教育和质量保证的必要性，以及对全科医生进行ABPM解读培训的必要性。
