Department of Family Medicine, University of Washington, Seattle, WA, USA.
Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA.
J Gen Intern Med. 2023 Jun;38(8):1854-1861. doi: 10.1007/s11606-023-08036-3. Epub 2023 Jan 17.
The US Preventive Services Task Force recommends measuring blood pressure (BP) outside of clinic/office settings. While various options are available, including home devices, BP kiosks, and 24-h ambulatory BP monitoring (ABPM), understanding patient acceptability and adherence is a critical factor for implementation.
To compare the acceptability and adherence of clinic, home, kiosk, and ABPM measurement.
Comparative diagnostic accuracy study which randomized adults to one of three BP measurement arms: clinic, home, and kiosk. ABPM was conducted on all participants.
Adults (18-85 years) receiving care at 12 Kaiser Permanente Washington primary care clinics (Washington State, USA) with a high BP (≥ 138 mmHg systolic or ≥ 88 mmHg diastolic) in the electronic health record with no hypertension diagnosis and on no hypertensive medications and with high BP at a research screening visit.
Patient acceptability was measured using a validated survey which was used to calculate an overall acceptability score (range 1-7) at baseline, after completing their assigned BP measurement intervention, and after completing ABPM. Adherence was defined based on the pre-specified number of BP measurements completed.
Five hundred ten participants were randomized (mean age 59 years), with mean BP of 150/88. Overall acceptability score was highest (i.e. most acceptable) for Home BP (mean 6.2, SD 0.7) and lowest (least acceptable) for ABPM (mean 5.0, SD 1.0); scores were intermediate for Clinic (5.5, SD 1.1) and Kiosk (5.4, SD 1.0). Adherence was higher for Home (154/170, 90.6%) and Clinic (150/172, 87.2%) than for Kiosk (114/168, 67.9%)). The majority of participants (467/510, 91.6%) were adherent to ABPM.
Participants found home BP measurement most acceptable followed by clinic, BP kiosks, and ABPM. Our findings, coupled with recent evidence regarding the accuracy of home BP measurement, further support the routine use of home-based BP measurement in primary care practice in the US.
ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
美国预防服务工作组建议在诊所/办公室环境之外测量血压（BP）。虽然有多种选择，包括家庭设备、BP 亭和 24 小时动态血压监测（ABPM），但了解患者的可接受性和依从性是实施的关键因素。
比较诊所、家庭、亭和 ABPM 测量的可接受性和依从性。
对接受 Kaiser Permanente Washington 12 家初级保健诊所（美国华盛顿州）护理的成年人进行比较诊断准确性研究，这些成年人的电子健康记录中有高血压（收缩压≥138mmHg 或舒张压≥88mmHg），但没有高血压诊断和高血压药物治疗，且在研究筛查就诊时血压较高。将成年人随机分配到三个 BP 测量臂之一：诊所、家庭和亭。对所有参与者进行 ABPM。
年龄在 18-85 岁之间的成年人，在电子健康记录中患有高血压（收缩压≥138mmHg 或舒张压≥88mmHg），但没有高血压诊断和高血压药物治疗，且在研究筛查就诊时血压较高，且在 Kaiser Permanente Washington 的 12 家初级保健诊所（美国华盛顿州）接受护理。
使用经过验证的问卷调查测量患者的可接受性，该问卷用于在基线时、完成指定的 BP 测量干预后以及完成 ABPM 后计算总体可接受性评分（范围 1-7）。依从性基于完成的预设 BP 测量次数定义。
随机分配了 510 名参与者（平均年龄 59 岁），平均血压为 150/88mmHg。家庭 BP 的总体可接受性评分最高（即最可接受）（平均 6.2，标准差 0.7），ABPM 的评分最低（最不可接受）（平均 5.0，标准差 1.0）；诊所（5.5，标准差 1.1）和亭（5.4，标准差 1.0）的评分居中。家庭（154/170，90.6%）和诊所（150/172，87.2%）的依从性高于亭（114/168，67.9%）。大多数参与者（467/510，91.6%）对 ABPM 依从。
参与者发现家庭 BP 测量最可接受，其次是诊所、BP 亭和 ABPM。我们的研究结果，加上最近关于家庭 BP 测量准确性的证据，进一步支持在美国初级保健实践中常规使用基于家庭的 BP 测量。
ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257。
