Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA.
Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA.
BMC Prim Care. 2023 Jan 25;24(1):30. doi: 10.1186/s12875-022-01950-1.
Early identification and control of hypertension is critical to reducing cardiovascular disease events and death. U.S. Preventive Services Task Force guidelines recommend health care professionals screen all adults for hypertension, yet 1 in 4 adults with hypertension are unaware of their condition. This gap between guidelines and clinical practices highlights an important opportunity to improve blood pressure (BP) screening and hypertension diagnosis, including measurement outside of clinic settings. To identify targets for future diagnostic interventions, we sought to understand primary care physicians' (PCPs) beliefs and practices regarding use of common forms of BP measurement.
Study participants were PCPs (N = 27) who had patients enrolled in the BP-CHECK trial. The trial compared the accuracy of 24-h ambulatory BP monitoring (ABPM) to: 1) clinic-based monitoring, 2) home BP monitoring (HBPM), or 3) use of a BP kiosk in clinics or pharmacies. Physicians were interviewed by phone and compensated for their participation. Interviews were recorded, transcribed, and analyzed using a template analysis approach.
Overall, PCPs preferred and trusted clinic BP measurement for diagnosing hypertension, particularly when measured with a manual sphygmomanometer. Concerns with HBPM included the belief that patients did not follow protocols for rest and body positioning at home, that home machines were not accurate, that home BPs could not be entered into the medical record, and that HBPM would make some patients anxious. Issues regarding kiosk measurement included beliefs that the public setting created stress for patients, that patients did not follow resting protocols when using kiosks, and concerns about the maintenance of these machines. ABPM was recognized as highly accurate but was not perceived as accessible. Additionally, some PCPs found it challenging to interpret the multiple readings generated by ABPM and HBPM, especially when these readings differed from clinic BPs.
Our findings suggest that both additional physician education and training and investments in equipment and system-level processes are needed to increase the acceptance and utilization of out of office BP measurement for identification and treatment of hypertension. These changes are needed to improve ensure everyone in the U.S receive optimal care for hypertension.
ClinicalTrials.gov NCT03130257 . Initial registration date: 4/21/2017.
早期识别和控制高血压对于降低心血管疾病事件和死亡至关重要。美国预防服务工作组指南建议医疗保健专业人员对所有成年人进行高血压筛查，但每 4 名高血压成年人中就有 1 人不知道自己的病情。这一指南与临床实践之间的差距突显了一个改善血压（BP）筛查和高血压诊断的重要机会，包括在诊所环境之外进行测量。为了确定未来诊断干预的目标，我们试图了解初级保健医生（PCPs）对使用常见 BP 测量形式的信念和做法。
研究参与者为参加 BP-CHECK 试验的 PCPs（N=27）。该试验比较了 24 小时动态血压监测（ABPM）与以下三种方法的准确性：1）诊所监测，2）家庭血压监测（HBPM），或 3）在诊所或药店使用 BP 亭。医生通过电话接受采访并获得参与补偿。使用模板分析方法对采访进行记录、转录和分析。
总体而言，PCPs 更喜欢并信任诊所 BP 测量用于诊断高血压，尤其是使用手动血压计进行测量时。对 HBPM 的担忧包括：患者在家中不遵守休息和体位的协议、家用机器不准确、家用 BP 无法录入病历以及 HBPM 会使一些患者感到焦虑等。关于 kiosk 测量的问题包括：认为公共环境会给患者带来压力、患者在使用 kiosk 时不遵守休息协议以及对这些机器的维护表示担忧。ABPM 被认为是高度准确的，但被认为不易获得。此外，一些 PCPs 发现解读 ABPM 和 HBPM 生成的多次读数具有挑战性，尤其是当这些读数与诊所 BP 不同时。
我们的研究结果表明，需要进一步加强医生教育和培训，并投资于设备和系统级流程，以增加对办公室外 BP 测量的接受度和利用率，从而识别和治疗高血压。这些变化是必要的，以确保美国的每个人都能获得最佳的高血压治疗。
ClinicalTrials.gov NCT03130257。初始注册日期：2017 年 4 月 21 日。
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