Rea Corinna J, Brady Tammy M, Bundy David G, Heo Moonseong, Faro Elissa, Giuliano Kimberly, Goilav Beatrice, Kelly Peterkaye, Orringer Kelly, Tarini Beth A, Twombley Katherine, Rinke Michael L
Division of General Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School.
Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
J Pediatr. 2022 Mar;242:12-17.e1. doi: 10.1016/j.jpeds.2021.11.008. Epub 2021 Nov 10.
To assess pediatrician adherence to the 2017 American Academy of Pediatrics' clinical practice guideline for high blood pressure (BP).
Pediatric primary care practices (n = 59) participating in a quality improvement collaborative submitted data for patients with high BP measured between November 2018 and January 2019. Baseline data included patient demographics, BP, body mass index (BMI), and actions taken. Logistic regression was used to test associations between patient BP level and BMI with provider adherence to guidelines (BP measurement, counseling, follow-up, evaluation).
A total of 2677 patient charts were entered for analysis. Only 2% of patients had all BP measurement steps completed correctly, with fewer undergoing 3-limb and ambulatory BP measurement. Overall, 46% of patients received appropriate weight, nutrition, and lifestyle counseling. Follow-up for high BP was recommended or scheduled in 10% of encounters, and scheduled at the appropriate interval in 5%. For patients presenting with their third high BP measurement, 10% had an appropriate diagnosis documented, 2% had appropriate screening laboratory tests conducted, and none had a renal ultrasound performed. BMI was independently associated with increased odds of counseling, but higher BP was associated with lower odds of counseling. Higher BP was independently associated with an increased likelihood of documentation of hypertension.
In this multisite study, adherence to the 2017 American Academy of Pediatrics' guideline for high BP was low. Given the long-term health implications of high BP in childhood, it is important to improve primary care provider recognition and management.
ClinicalTrials.gov: NCT03783650.
评估儿科医生对2017年美国儿科学会高血压临床实践指南的遵循情况。
参与质量改进协作项目的59家儿科初级保健机构提交了2018年11月至2019年1月期间测量血压偏高患者的数据。基线数据包括患者人口统计学信息、血压、体重指数（BMI）以及采取的措施。采用逻辑回归分析来检验患者血压水平和BMI与医疗服务提供者遵循指南情况（血压测量、咨询、随访、评估）之间的关联。
共录入2677份患者病历进行分析。只有2%的患者所有血压测量步骤均正确完成，进行三肢体血压测量和动态血压测量的患者更少。总体而言，46%的患者接受了适当的体重、营养和生活方式咨询。10%的就诊中建议或安排了高血压随访，5%的随访安排在适当的间隔时间。对于第三次测量血压偏高的患者，10%有适当的诊断记录，2%进行了适当的筛查实验室检查，且无人进行肾脏超声检查。BMI独立与咨询几率增加相关，但血压较高与咨询几率较低相关。血压较高独立与高血压记录可能性增加相关。
在这项多中心研究中，对2017年美国儿科学会高血压指南的遵循率较低。鉴于儿童期高血压对长期健康的影响，提高初级保健提供者的认识和管理水平很重要。
ClinicalTrials.gov：NCT03783650。
