Clinician accountability in a primary care clinic time-interval blood pressure measurements study: Practice implications

2019 ◽  
Vol 45 ◽  
pp. 69-72
Author(s):  
Johnny R. Tice ◽  
Leslie G. Cole ◽  
Stephen M. Ungvary ◽  
Safiya D. George ◽  
JoAnn S. Oliver
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Clinic ◽  
Time Interval ◽  
Pressure Measurements ◽  
Care Clinic

scholarly journals Implementation of a New Kiosk Technology for Blood Pressure Management in a Community-Based Primary Care Clinic

2017 ◽  
Vol 4 (3) ◽  
pp. 185
Author(s):  
Beverly Green ◽  
Chai-Fung Chung ◽  
Sean A. Munson ◽  
Matthew J. Thompson ◽  
Laura-Mae Baldwin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Clinic ◽  
Pressure Management ◽  
Community Based ◽  
Care Clinic ◽  
Blood Pressure Management

Abstract P134: Selected Social Determinants Of Health And Hypertension For Patients Of An Urban Community Primary Care Clinic

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Melvin R Echols ◽  
Paula Pollard-Thomas ◽  
Henry Nuss ◽  
Heartley Egwuogu ◽  
Kristen Hobbs ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
African American ◽  
Food Insecurity ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Clinic ◽  
Financial Strain ◽  
Care Clinic ◽  
Stage 1

Background: Hypertension (HTN) is the most potent cardiovascular disease worldwide and a major public health concern in the U.S. Although Social Determinants of Health (SDoH) are associated with HTN, it is unclear whether these indicators are routinely captured in the primary care setting. We sought to examine the prevalence of any HTN and its association with captured SDoH for new patients (pts) presenting to an urban community primary care clinic for 2019 and 2020. Methods and Results: We identified a cohort-based, cross-sectional sample of 2,577 new pts ≥ 18 years of age in a community clinic in Atlanta, GA, between Jan 2019 and Dec 2020. Electronic health records were reviewed to determine the rate of selected SDoH indicators (financial strain, transportation, medical transportation, and food insecurity) captured at any time and the presenting blood pressure for all new patients. Blood pressure was classified as follows: normal, systolic BP/diastolic BP (SBP/DBP) ≤120/80 mmHg, elevated SBP 120-129mmHg and DBP<80mm, stage 1 SBP 130-139mmHg or DBP 80-90mmHg, and stage 2 SBP ≥ 140mmHg+ or DBP 90mmHg+. Likelihood-ratio Chi-square tests were analyzed to detect an association between SDOH and stages of HTN. Of the 2,577 pts seen, 93% were African American, 72% were female, 59% were single, 77% had BMI ≥ 25, and 85% were insured. Only 41% (n=1062) pts had information of at least one SDoH measure in the entire cohort. Of the SDoH domains evaluated, financial strain and food insecurity were more likely in new pts with stage 1 HTN or higher (χ2= 16.0, df=8, p=0.04; χ2= 27.7, df=12, p=0.006). Conclusion: Routine assessments of SDoH for African American pts presenting for new pt visits are suboptimal in the primary care setting. However, financial strain and food insecurity are significantly associated with stage 1 and 2 HTN in this population. Standardization of intake processes is essential to increase the collection of SDoH indicators and may ultimately guide secondary prevention strategies for HTN interventions.

scholarly journals Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Gabriel U.P. Iloh ◽  
John N. Ofoedu ◽  
Patrick U. Njoku ◽  
Agwu N. Amadi ◽  
Ezinne U. Godswill-Uko
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Primary Care Clinic ◽  
Tertiary Hospital ◽  
Primary Hypertension ◽  
Detection Rates ◽  
Care Clinic ◽  
Adherence To Medication

Background: As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge.Objectives: To describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria.Methods: A cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented.Results: Adherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03), antihypertensive medication duration ≥3 years (p = 0.042), and taking ≥ one form of antihypertensive medication (p = 0.04). BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036). The most common reason for non-adherence was forgetfulness (p = 0.046).Conclusion: The rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

scholarly journals Prescribing patterns of antihypertensive medications and blood pressure control among hypertensive patients in a primary care setting in Malaysia

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Jun-Ming Ng ◽  
Kok Pim Kua ◽  
Shaun Wen Huey Lee
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Control ◽  
Primary Care Clinic ◽  
Care Facility ◽  
Pressure Control ◽  
Prescribing Patterns ◽  
Antihypertensive Medications ◽  
Care Clinic ◽  
Utilisation Data

Aims: This study aims to describe the prescribing patterns of antihypertensive medications and short term outcomes of these patients, defined as repeat blood pressure measurements by a medical professional within 6 months, in a primary care facility in Puchong, located within the state of Selangor in Malaysia. Methods: This study was a cross-sectional, retrospective analysis of patients with essential hypertension, aged 18 and above, with blood pressure recorded at least twice within a 6-month period in an urban primary care clinic in Malaysia. Patients with history of co-morbidities were excluded. The prescribing patterns of antihypertensive medications and proportion of patients who achieved blood pressure control of less than 140/90 mmHg were ascertained. Results: A total of 200 prescriptions were analysed, including 52.5% females taking a mean of 1.7 (0.7) antihypertensive medications with a mean age of 57.9 (12.4) years. Most of the patients were prescribed either a single medication (n=90, 45.0%) or two medications (n=90; 45.0%) to control their blood pressure. Only 20 patients (10.0%) were prescribed three antihypertensive medications. A total of 127 (63.5%) patients met the blood pressure target of less than 140/90 mmHg. All participants exhibited a significant drop in systolic blood pressure, reducing from 143.0 (16.0) mmHg at baseline to 135.3 (14.8) mmHg at the end of 6 months (p<0.001). Diastolic blood pressure also decreased significantly from 83.5 (11.7) mmHg at baseline to 79.0 (10.2) mmHg at the end of 6 months (p<0.001). The choice of antihypertensive medications by the prescribers was compliant with the hypertension guidelines of Malaysia. Conclusion: The most commonly prescribed antihypertensive class was calcium channel blockers. Significant reduction in blood pressure was observed in patients from baseline to the follow-up visit. Further research of larger sample size and longer monitoring period is necessary to provide more robust epidemiology and drug utilisation data.

Direct-Observation Cohort Study of Shared Decision Making in a Primary Care Clinic

2020 ◽  
Vol 40 (6) ◽  
pp. 756-765 ◽  
Author(s):  
Jeffrey L. Jackson ◽  
Derek Storch ◽  
Wilkins Jackson ◽  
Dorothy Becher ◽  
Patrick G. O’Malley
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Decision Making ◽  
Medical Decision Making ◽  
Primary Care Clinic ◽  
Small Sample ◽  
Medical Decision ◽  
Objective Measures ◽  
Care Clinic

Background. Observational studies suggest that shared medical decision making (SMDM) is suboptimal. Our objective was to assess patient preferences, ratings, and objective measurements of decision making and their impact on patient outcomes. Methods. Hypertensive adults presenting for routine care with their primary care physician completed previsit surveys assessing SMDM preferences. Postvisit surveys assessed the degree of SMDM during the encounter, patient satisfaction, and trust. Encounters were audiotaped and transcripts were coded for type of decisions made as well as SMDM quality using OPTION-5. Adherence and blood pressure were measured at baseline and at 4 weeks. Results. Among 105 encounters, there were 7.4 decisions per visit; most were basic, such as refills and routine testing. Objective measures of decision making indicated that the degree of SMDM was lower than reported by patients or physicians, although physician ratings were more accurate. Previsit, 54% of patients expressed a desire for equally shared medical decision making, 24% preferred physician dominated decision making, and 18% preferred that they make the decisions. Postvisit, patients reported experiencing SMDM in 57% of encounters, with high concordance between desired and perceived decision making. Discordance between the patient’s desired and experienced SMDM reduced trust and satisfaction. The quality of shared decisions had no impact on adherence or blood pressure at 4 weeks. Limitations. Single site, small sample. Conclusions. Decisions are common during internal medicine primary care visits, and most are basic. Most patients preferred SMDM, and their perceptions of the visit decision-making style were concordant with their preferences although higher than objective measures suggested. Physician ratings of the quality of SMDM were more accurate than patient ratings. Discordance between patients’ expected and experienced SMDM lowered satisfaction and trust.

scholarly journals Number of blood pressure measurements needed to estimate long-term visit-to-visit systolic blood pressure variability for predicting cardiovascular risk: a 10-year retrospective cohort study in a primary care clinic in Malaysia

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025322 ◽  
Author(s):  
Hooi Min Lim ◽  
Yook Chin Chia ◽  
Siew Mooi Ching ◽  
Karuthan Chinna
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Clinical Practice ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Primary Care Clinic ◽  
Care Clinic

ObjectiveTo determine the reproducibility of visit-to-visit blood pressure variability (BPV) in clinical practice. We also determined the minimum number of blood pressure (BP) measurements needed to estimate long-term visit-to-visit BPV for predicting 10-year cardiovascular (CV) risk.DesignRetrospective studySettingA primary care clinic in a university hospital in Malaysia.ParticipantsRandom sampling of 1403 patients aged 30 years and above without any CV event at baseline.Outcomes measuresThe effect of the number of BP measurement for calculation of long-term visit-to-visit BPV in predicting 10-year CV risk. CV events were defined as fatal and non-fatal coronary heart disease, fatal and non-fatal stroke, heart failure and peripheral vascular disease.ResultsThe mean 10-year SD of systolic blood pressure (SBP) for this cohort was 13.8±3.5 mm Hg. The intraclass correlation coefficient (ICC) for the SD of SBP based on the first eight and second eight measurements was 0.38 (p<0.001). In a primary care setting, visit-to-visit BPV (SD of SBP calculated from 20 BP measurements) was significantly associated with CV events (adjusted OR 1.07, 95% CI 1.02 to 1.13, p=0.009). Using SD of SBP from 20 measurement as reference, SD of SBP from 6 measurements (median time 1.75 years) has high reliability (ICC 0.74, p<0.001), with a mean difference of 0.6 mm Hg. Hence, a minimum of six BP measurements is needed for reliably estimating intraindividual BPV for CV outcome prediction.ConclusionLong-term visit-to-visit BPV is reproducible in clinical practice. We suggest a minimum of six BP measurements for calculation of intraindividual visit-to-visit BPV. The number and duration of BP readings to derive BPV should be taken into consideration in predicting long-term CV risk.

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