Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Health Economics Unit, University of Birmingham, Birmingham, UK.
BMJ Open. 2019 May 29;9(5):e027986. doi: 10.1136/bmjopen-2018-027986.
To assess the feasibility of using a blood pressure (BP) self-measurement kiosk-a solid-cuff sphygmomanometer combined with technology to integrate the BP readings into patient electronic medical records- to improve hypertension detection.
A concurrent mixed-methods feasibility study incorporating observational and qualitative interview components.
Two English general practitioner (GP) surgeries.
Adult patients registered at participating surgeries. Staff working at these sites.
BP self-measurement kiosks were placed in the waiting rooms for a 12-month period between 2015 and 2016 and compared with a 12-month control period prior to installation.
(1) The number of patients using the kiosk and agreeing to transfer of their data into their electronic medical records; (2) the cost of using a kiosk compared with GP/practice nurse BP screening; (3) qualitative themes regarding use of the equipment.
Out of 15 624 eligible patients, only 186 (1.2%, 95% CI 1.0% to 1.4%) successfully used the kiosk to directly transfer a BP reading into their medical record. For a considerable portion of the intervention period, no readings were transferred, possibly indicating technical problems with the transfer link. A comparison of costs suggests that at least 52.6% of eligible patients would need to self-screen in order to bring costs below that of screening by GPs and practice nurses. Qualitative interviews confirmed that both patients and staff experienced technical difficulties, and used alternative methods to enter BP results into the medical record.
While interviewees were generally positive about checking BP in the waiting room, the electronic transfer system as tested was neither robust, effective nor likely to be a cost-effective approach, thus may not be appropriate for a primary care environment. Since most of the cost of a kiosk system lies in the transfer mechanism, a solid-cuff sphygmomanometer and manual entry of results may be a suitable alternative.
评估使用血压（BP）自助测量亭（一种带技术的固袖血压计，可将血压读数整合到患者电子病历中）提高高血压检出率的可行性。
一项包含观察和定性访谈内容的同期混合方法可行性研究。
两家英国全科医生（GP）诊所。
在参与手术的患者中登记的成年患者。在这些地点工作的工作人员。
2015 年至 2016 年期间，在候诊室放置血压自助测量亭 12 个月，并与安装前的 12 个月对照期进行比较。
在 15624 名符合条件的患者中，只有 186 名（1.2%，95%CI 1.0%至 1.4%）成功使用该亭将血压读数直接传输到他们的电子病历中。在干预期的相当一部分时间内，没有传输读数，可能表明传输链接存在技术问题。对成本的比较表明，至少需要 52.6%的符合条件的患者进行自我筛查，才能使成本低于由 GP 和执业护士进行筛查的成本。定性访谈证实，患者和工作人员都遇到了技术难题，并使用替代方法将血压结果输入病历。
尽管受访者普遍对在候诊室检查血压持积极态度，但测试的电子传输系统既不稳健、有效，也不太可能具有成本效益，因此可能不适合初级保健环境。由于自助亭系统的大部分成本在于传输机制，因此固袖血压计和手动输入结果可能是一种合适的替代方案。
