Hwang Kevin O, Aigbe Aitebureme, Ju Hsiao-Hui, Jackson Victoria C, Sedlock Emily W
1 UTHealth McGovern Medical School, Houston, TX, USA.
2 University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX, USA.
J Prim Care Community Health. 2018 Jan-Dec;9:2150132718816929. doi: 10.1177/2150132718816929.
Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate BP measurements in routine practice. We investigated barriers affecting measurement of BP for adult patients in primary care.
We conducted a qualitative evaluation in 6 adult primary care clinics. BP measurement was observed during 54 routine patient encounters. Six managers completed semistructured interviews and 18 clinical staff members participated in focus group discussions. We used an inductive, data-driven approach to identify and organize findings into cohesive, overarching themes describing factors affecting BP measurement.
Observed errors in BP measurement spanned the entire spectrum of steps required to obtain BP properly. Barriers to proper BP measurement were related to staff knowledge and behavior (inadequate knowledge, training, and feedback); workflow constraints (need to multitask, inadequate time); and equipment issues (BP monitors, seating). Patient characteristics and behavior also affected BP measurement.
Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care. These findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.
尽管门诊环境中血压（BP）测量误差的发生率很高，但对于基层医疗诊所为何在日常实践中难以始终获得准确的血压测量结果，人们知之甚少。我们调查了影响基层医疗中成年患者血压测量的障碍因素。
我们在6家成人基层医疗诊所进行了定性评估。在54次常规患者诊疗过程中观察血压测量情况。6名管理人员完成了半结构化访谈，18名临床工作人员参加了焦点小组讨论。我们采用归纳法、数据驱动的方法来识别并将研究结果组织成连贯的、总体性的主题，以描述影响血压测量的因素。
观察到的血压测量误差涵盖了正确测量血压所需的各个步骤。正确测量血压的障碍与工作人员的知识和行为（知识不足、培训不足和反馈不足）、工作流程限制（需要同时处理多项任务、时间不足）以及设备问题（血压监测仪、座位）有关。患者的特征和行为也会影响血压测量。
血压的正确测量受到多种因素的影响，在基层医疗中持续实现具有挑战性。这些发现可为绩效改进计划的设计提供参考，以在门诊环境中最大限度地提高血压测量质量。
