Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (M Goulding, G Ryan, C Frisard, E Stevens, A Garg, and SC Lemon), University of Massachusetts Chan Medical School, Worcester, Mass.
Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences (S Person), University of Massachusetts Chan Medical School, Worcester, Mass.
Acad Pediatr. 2024 Apr;24(3):506-513. doi: 10.1016/j.acap.2023.07.006. Epub 2023 Jul 23.
To describe adherence to the American Academy of Pediatrics' (AAP) 2017 clinical practice guidelines for follow-up after high blood pressure (BP) screening by pediatric and family medicine providers in a Massachusetts health care system and to assess differences in receipt of follow-up according to child- and clinic-level factors.
Electronic health record data were analyzed for children aged 3 to 17years who had an outpatient primary care visit during 2018 with a high BP screening (according to AAP guidelines). We classified AAP guideline adherent follow-up as BP follow-up within 6months after an elevated finding (+2-week buffer) and within 2weeks after a hypertensive finding (+2-week buffer). Differences in receipt of guideline adherent follow-up by child- and clinic-level factors were assessed via multilevel mixed effects logistic regression models.
The median age of the 4563 included children was 12years and 43% were female. Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval; 27.4% for those whose index BP was elevated and 5.4% for those whose index BP was hypertensive. Modeling revealed older children and those belonging to clinics with more providers, smaller patient panels, and smaller proportion of Medicaid patients were more likely to receive adherent follow-up.
Few children received guideline adherent BP follow-up and most differences in adherence were related to clinic resources. System-level interventions are needed to improve BP follow-up.
描述在马萨诸塞州医疗系统中，儿科和家庭医学提供者对高血压（BP）筛查后遵循美国儿科学会（AAP）2017 年临床实践指南的情况，并评估根据患儿和诊所水平因素接受随访的差异。
对 2018 年门诊初级保健就诊时进行高血压筛查（根据 AAP 指南）的 3 至 17 岁儿童的电子健康记录数据进行分析。我们将 AAP 指南一致的随访定义为在发现升高后 6 个月内（+2 周缓冲期）和高血压发现后 2 周内（+2 周缓冲期）进行 BP 随访。通过多级混合效应逻辑回归模型评估患儿和诊所水平因素对接受指南一致的随访的差异。
纳入的 4563 名儿童的中位年龄为 12 岁，其中 43%为女性。总体而言，17.7%的儿童在推荐的时间间隔内接受了符合指南的随访；指数 BP 升高的儿童为 27.4%，指数 BP 高血压的儿童为 5.4%。模型显示，年龄较大的儿童和属于具有更多提供者、较小患者群体和较少医疗补助患者比例的诊所的儿童更有可能接受符合指南的随访。
很少有儿童接受符合指南的 BP 随访，大多数依从性差异与诊所资源有关。需要系统层面的干预措施来改善 BP 随访。
