An ongoing challenge: why do primary care providers struggle to adhere to blood pressure guidelines?

2021 ◽  
Author(s):  
Mark M. Mitsnefes ◽  
Christopher Bolling
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers

Abstract TP206: The Influence of Contextual Factors on Gaps in Hypertension Management for Veterans with TIA/Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Edward J Miech ◽  
Teresa M Damush ◽  
Ava B Keating ◽  
Gregory W Arling ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Contextual Factors ◽  
Primary Care Providers ◽  
Minor Stroke ◽  
Medical Attention ◽  
Hypertension Management ◽  
Cerebrovascular Event ◽  
Care Providers ◽  
Provider Perspectives

Introduction: Many patients with TIA/minor stroke do not achieve goal blood pressure their cerebrovascular event, thereby remaining at high risk for future events. Understanding the influence of contextual factors associated with post-event hypertension management may inform future intervention studies. Methods: As part of a national, observational study of TIA/minor stroke care across the Veterans Health Administration (VHA), in-person site visits were conducted at participating VHA medical centers in 2014-15. Semi-structured interviews were used to elicit provider perspectives about local practices related to the care of TIA/minor stroke patients. Study team members systematically applied codes transcribed files using qualitative, categorical, and quantitative descriptive codebooks. Investigators used Thematic Content Analysis and mixed-methods matrix displays to analyze coded data, generate, and then validate findings. Results: Seventy interviews were obtained from staff at 14 sites. Several contextual factors appeared to influence post-event hypertension care delivery for patients after a TIA/minor stroke. Neurologists reported that they perceived no direct responsibility for managing post-event blood pressure and were uncertain whether recommendations regarding blood pressure management were being implemented in primary care. Primary care providers expressed hesitancy about titrating antihypertensive medications post-event, citing concerns about permissive hypertension. Providers also reported that poor blood pressure control was not as salient to patients as symptoms, leading some patients to not adhere to their antihypertensives or not feel a sense of urgency in seeking prompt medical attention. VHA facilities did not have protocols to guide providers in the treatment of post-TIA/minor stroke hypertension, with centers expressing little compulsion to develop them. Conclusions: Multiple contextual factors at the provider- and system-levels were identified as barriers to achieving post-cerebrovascular event hypertension control; these data have informed the design of a recently funded vascular risk factor intervention.

scholarly journals Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers (Preprint)

2018 ◽  
Author(s):  
Sarah Rodriguez ◽  
Kevin Hwang ◽  
Jing Wang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Focus Group ◽  
Care Setting ◽  
Primary Care Setting ◽  
Visual Display ◽  
Primary Care Providers ◽  
Critical Value ◽  
Care Providers ◽  
Home Based

BACKGROUND There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. OBJECTIVE The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. METHODS A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. RESULTS The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. CONCLUSIONS The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes.

scholarly journals Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Innocent K. Besigye ◽  
Vicent Okuuny ◽  
Mari Armstrong-Hough ◽  
Anne R. Katahoire ◽  
Nelson K. Sewankambo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Point Of Care ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Health Providers ◽  
Care Providers ◽  
Tororo District ◽  
Key Informant ◽  
Care Facilities

Background: Early diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Methods: This was an explanatory sequential mixed-methods study combining a structured facility checklist and key informant interviews with primary care providers. The checklist was used to collect data on availability and functionality of BP machines within their organisational arrangements. Key informant interviews explored health providers’ access to BP machines.Results: The majority of health facilities reported at least one working BP machine. However, Health providers described limited access to machines because they are not located at each point of care. Health providers reported borrowing amongst themselves within their respective units or from other units within the facility. Some health providers purchase and bring their own BP machines to the health facilities or attempted to restore the functionality of broken ones. They are motivated to search the clinic for BP machines for some patients but not others based on their perception of the patient’s risk for hypertension.Conclusion: Access to BP machines at the point of care was limited. This makes hypertension screening selective based on health providers’ perception of the patients’ risk for hypertension. Training in proper BP machine use and regular maintenance will minimise frequent breakdowns.

A 12-Week Evidence-Based Education Project to Reduce Cardiovascular and Metabolic Risk in Adults With Serious Mental Illness in the Integrated Care Setting

2020 ◽  
pp. 107839032090282 ◽  
Author(s):  
Ashley Fenton ◽  
Phyllis Sharps ◽  
Karan Kverno ◽  
Jill RachBeisel ◽  
Marsha Gorth
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Hemoglobin A1c ◽  
Self Care ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Care Providers ◽  
Schizophrenia Spectrum Disorders

BACKGROUND: Individuals with serious mental illness (SMI) such as schizophrenia spectrum disorders, severe bipolar disorder, or severe recurrent major depressive disorder have a shorter life expectancy compared with those in the general population. This is largely due to the higher rates of diabetes, hyperlipidemia, and hypertension. Treatment adherence, diet, exercise, and weight management are modifiable risk factors for these cardiometabolic conditions, yet the use of educational lifestyle interventions is not common practice in the clinical setting. OBJECTIVE: The purpose of this project was to evaluate a 12-week evidence-based diabetes prevention education program integrated into a primary care behavioral health setting for adults with SMI, diabetes, or prediabetes, and who were overweight or obese. STUDY DESIGN: Outcomes for this project included diabetes knowledge, self-care, and health indicators (blood pressure, hemoglobin A1C, weight, body mass index, and medication adherence). The project also addressed feasibility and acceptability of the program in this setting. RESULTS: Project outcomes showed a reduction in weight, waist circumference, hemoglobin A1C, and blood pressure. Outcomes also indicated an improvement in participants’ self-knowledge and self-care. CONCLUSIONS: There was a high attendance rate and overall acceptability and feasibility described by participants. This project highlights the important role that primary care providers can play in providing health education to patients with SMI.

scholarly journals P047: Prevalence and severity of hypertension presenting to Calgary area emergency departments

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S73-S73
Author(s):  
K. Eppler ◽  
D. Wang ◽  
T.P. Pollak ◽  
E.S. Lang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Early Recognition ◽  
Primary Care Providers ◽  
High Risk Population ◽  
Care Providers ◽  
Hypertensive Urgency

Introduction: Hypertension is common and a major cause of morbidity and mortality. Because it is asymptomatic, its diagnosis is often delayed. For many Canadians the Emergency Department (ED) is the only point of entry to the health care system, and therefore the recognition of undiagnosed and untreated hypertension in the ED is increasingly important. This study sought to evaluate the prevalence and severity of hypertension in patients presenting to Calgary area EDs, as well as to determine whether medical therapy was initiated and if patients had primary care providers for follow-up. Methods: Multi-centre electronic medical record (EMR) review of all adult patients presenting to Calgary area EDs from January 1, 2016 to December 31st, 2016. Hypertension was coded electronically by triage nurses and defined as systolic blood pressure SBP 140 mmHg and/or diastolic blood pressure DBP 90 mmHg. Hypertensive urgency was defined as SBP 180 mmHg and/or DBP 120 mmHg. Descriptive data was used to show patient demographics and hypertension prevalence. Primary care provider status, previous diagnosis of hypertension, chief complaint, and ED diagnoses were extracted and the EMRs were manually searched to determine whether treatment was initiated in the ED. Results: Of 304392 patients presenting to all Calgary sites, 43055 (14%) were found to have hypertension; mean age 52 (range 18 to 104), female 42%. Of these, 32986 (77%) had no known previous hypertension and 31% lacked a primary care provider. 0.2% had documentation of treatment initiated in the ED. 16% met criteria for hypertensive urgency. Conclusion: Many patients presenting to the ED have hypertension, often previously undiagnosed and at times severe. Many lack access to primary care. EDs may play an important role in the early recognition of hypertension. Dedicated management and follow-up pathways are indicated for this high-risk population.

scholarly journals Prevalence Rates of Self-Care Behaviors and Related Factors in a Rural Hypertension Population: A Questionnaire Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Huanhuan Hu ◽  
Gang Li ◽  
Takashi Arao
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Physical Exercise ◽  
Self Care ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Health Practitioner ◽  
Care Providers ◽  
Hypertensive Patients ◽  
Diabetes Status

The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

Abstract 309: Prioritizing Blood Pressure Measurements Results In Improved Hypertension Control

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Olufunso W Odunukan ◽  
Stephen Cha ◽  
Ahmed S Rahman ◽  
Daniel Roellinger ◽  
James M Naessens ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Blood Pressure ◽  
Primary Care ◽  
Preventive Medicine ◽  
Primary Care Providers ◽  
Performance Measure ◽  
Hypertension Management ◽  
Care Providers ◽  
Hypertension Control ◽  
Intermediate Outcomes

Background: Blood pressure (BP) measurement is a national core quality measure for hypertension care and hypertension control rates remain a major performance measure. It remains unclear whether improving measurement directly results in better control rates in hypertension management. Purpose: To utilize electronic medical records to explore the relationship between measurement of blood pressure and hypertension control rates among 4 eligible primary care providers groups - Primary Care Internal Medicine (PCIM), Family medicine (FM), General Internal Medicine (GIM), Preventive Medicine (PREV) - and 2 eligible specialist groups - Cardiology (CARD), Nephrology (NEPH) at an academic group medical practice. Methods: A two year cross sectional study involving adults seen by eligible primary or specialist providers at 2 or more office visits with a hypertension ICD-9 code in two years with at least one office visit in the measurement year. We measured the proportion of patients who had their BP measured at their last hypertension visit (LHV) in 2009 and 2010. We compared measurement rates with control rates as defined by the proportion of hypertension patients with BP < 140/90 mmHg at their LHV. Results: In 2009, 84.2% of 17989 patients (95% CI 83.6 - 84.7%) had their BP measured at their LHV compared to 85.3% (95% CI 84.8 - 85.8%) of 17992 patients in 2010, an increase of 1.2% (p=0.0026). Measurement rates varied widely across the different provider groups. PCIM, a high performing group, had significant improvement in measurement rates from 2009 to 2010 and demonstrated improvement in control rates. Lower performing groups, Nephrology and GIM, had significant improvement in measurement but did not see a direct translation to improved control rates. There was an associated worsening of the control rates for Preventive medicine along with a decrease in the measurement rates from 2009 to 2010. Conclusion: High BP measurement rates are associated with high hypertension control rates. Prioritizing BP measurement may result in improved intermediate outcomes in hypertension management.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Sign in / Sign up

Export Citation Format

Share Document