Abstract P052: The Effect of Re-designing Workflow and Introducing Automated Blood Pressure Devices in Community-based Primary Care Clinics

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Romsai T Boonyasai ◽  
Greg P Prokopowicz ◽  
Jeanne Charleston ◽  
Kathryn A Carson ◽  
Gary J Noronha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Measurement ◽  
Clinical Inertia ◽  
Intervention Period ◽  
Post Intervention ◽  
Community Based ◽  
Primary Care Clinics ◽  
Clinic Staff ◽  
Measurement Protocol

BACKGROUND: Prior studies report that poor technique and terminal digit preference (TDP) can distort blood pressure (BP) estimates in clinical settings. These limitations may bias population BP estimates, increase clinician workload, and contribute to clinical inertia. HYPOTHESIS: We hypothesized that BP measurement training with an automated blood pressure measurement (aBPM) device would reduce TDP, reduce the number of times clinicians repeat staff-obtained measurements, and reduce average BP estimates within each site. METHODS: We replaced aneroid BP measurement devices in 6 community-based primary care clinics with aBPM devices (Omron HEM-907XL) and trained clinic staff with a standardized BP measurement protocol using 1 hour presentations and follow-up visits. We report mean weekly BP measured in the 8 weeks pre- and 4 weeks post-intervention at the first intervention site. Results are analyzed using chi-squared and paired t-tests. RESULTS: Clinic staff recorded 5796 BP readings in the 8 week pre-intervention period and 2321 readings in the 4 weeks post-intervention period. TDP and clinician workload improved after the intervention. Pre-intervention, 1941 of 4833 (40.2%) of systolic BP and 2199 of 4833 (45.5%) of diastolic BP ended in zero, in contrast to 216 of 2158 (10.0%) of systolic and 219 of 2158 (10.2%) of diastolic readings post-intervention (P<.001 for both SBP and DBP). Clinicians repeated BP obtained by staff in 963 of 5796 (16.6%) of visits pre-intervention but only in 163 of 2321 (7.0%) of visits post-intervention (P<.001). TDP persisted when clinicians repeated staff-obtained BP readings post-intervention: 58 of 163 (35.6%) systolic and 65 of 163 (35.7%) diastolic BP ended in zero (P=.32 for SBP and P=.35 for DBP in comparison with pre-intervention BP readings). Overall, BP estimates changed modestly following the intervention. Post-intervention, mean systolic BP rose 1.4 mmHg (P=.004) and diastolic BP declined 3.1 mmHg (P<.001). Among clinician-repeated BP readings, systolic BP rose 2.4 mmHg (P=.12 for pre/post change) and diastolic BP declined 0.4 mmHg (P=.72 for pre/post change). CONCLUSIONS: A standardized BP measurement protocol used with an aBPM device in community-based primary care settings can reduce TDP and clinician workload but is associated with only modest change in population BP estimates.

scholarly journals Barriers to Accurate Blood Pressure Measurement in the Medical Office

2018 ◽  
Vol 9 ◽  
pp. 215013271881692 ◽  
Author(s):  
Kevin O. Hwang ◽  
Aitebureme Aigbe ◽  
Hsiao-Hui Ju ◽  
Victoria C. Jackson ◽  
Emily W. Sedlock
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Measurement Errors ◽  
Blood Pressure Measurement ◽  
Outpatient Setting ◽  
Routine Practice ◽  
Primary Care Clinics ◽  
Wide Range ◽  
Improvement Programs ◽  
And Behavior

Background: Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate BP measurements in routine practice. We investigated barriers affecting measurement of BP for adult patients in primary care. Methods: We conducted a qualitative evaluation in 6 adult primary care clinics. BP measurement was observed during 54 routine patient encounters. Six managers completed semistructured interviews and 18 clinical staff members participated in focus group discussions. We used an inductive, data-driven approach to identify and organize findings into cohesive, overarching themes describing factors affecting BP measurement. Results: Observed errors in BP measurement spanned the entire spectrum of steps required to obtain BP properly. Barriers to proper BP measurement were related to staff knowledge and behavior (inadequate knowledge, training, and feedback); workflow constraints (need to multitask, inadequate time); and equipment issues (BP monitors, seating). Patient characteristics and behavior also affected BP measurement. Conclusions: Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care. These findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.

scholarly journals Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Suzanne Leahy ◽  
Katie Ehlman ◽  
Lisa Maish ◽  
Brad Conrad ◽  
Jillian Hall ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Preliminary Evaluation ◽  
Language And Literacy ◽  
Community Based ◽  
Primary Care Clinics ◽  
College Of Nursing ◽  
Value Based Care ◽  
The University

Abstract Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

scholarly journals A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

2016 ◽  
Vol 26 (1) ◽  
pp. 27 ◽  
Author(s):  
Nancy R. Kressin ◽  
Judith A. Long ◽  
Mark E. Glickman ◽  
Barbara G. Bokhour ◽  
Michelle B. Orner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Communication Skills ◽  
Pressure Control ◽  
Control Site ◽  
Clinical Inertia ◽  
Improve Blood Pressure Control ◽  
Clinician Training ◽  
Primary Care Clinics ◽  
Tailored Interventions ◽  
Race Disparities

<p><strong>Background</strong>. Poor blood pressure (BP) control and racial disparities therein may be a function of clinical inertia and ineffective communication about BP care.</p><p><strong>Methods. </strong>We compared two different interventions (electronic medical record  reminder for BP care (Reminder only [RO]), and clinician training on BP care-related communication skills plus the reminder (Reminder + Training, [R+T]) with usual care in three primary care clinics, examining BP outcomes among 8,866 patients, and provider-patient communication and medication adherence among a subsample of 793.</p><p><strong>Results. </strong>Clinician counseling improved most at R+T.  BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. </p><p><strong>Conclusions. </strong>More substantial or racial/ethnically tailored interventions are needed. Ethn Dis. 2016;26(1):27-36; doi: 10.18865/ed.26.1.27</p>

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

Impact of Hypertension Guideline Implementation on Blood Pressure Control and Drug Use in Primary Care Clinics

1999 ◽  
Vol 25 (2) ◽  
pp. 68-77 ◽  
Author(s):  
Patrick J. O’Connor ◽  
Elaine S. Quiter ◽  
William A. Rush ◽  
Mark Wiest ◽  
Jeffrey T. Meland ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Drug Use ◽  
Blood Pressure Control ◽  
Guideline Implementation ◽  
Pressure Control ◽  
Primary Care Clinics ◽  
Hypertension Guideline

scholarly journals Impact of a University-Community Partnership Approach to Improving Health Behaviors and Outcomes Among Overweight/Obese Hispanic Adults

2016 ◽  
Vol 11 (6) ◽  
pp. 479-488 ◽  
Author(s):  
Carolyn M. Tucker ◽  
Tasia M. Smith ◽  
Guillermo M. Wippold ◽  
Nicole E. Whitehead ◽  
Tara A. Morrissette ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Healthy Eating ◽  
Intervention Group ◽  
Control Group ◽  
Post Intervention ◽  
Community Based ◽  
Hispanic Adults ◽  
Waitlist Control Group ◽  
Health Promotion Interventions

Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.

scholarly journals PrEP in Primary Care; Health Care Worker Adaptations to PrEP Delivery in Eswatini

2020 ◽  
Author(s):  
Kate Barnighausen ◽  
Sarah Dalglish ◽  
Sindy Matse ◽  
Allison Hughey ◽  
Anita Hettema ◽  
...  
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Southern Africa ◽  
Program Implementation ◽  
Real World ◽  
Scale Up ◽  
Community Based ◽  
Sexually Transmitted ◽  
Primary Care Clinics ◽  
Fast Tracking

Abstract BackgroundImplementation evidence for pre-exposure prophylaxis (PrEP) for the general population in primary-care clinics in Southern Africa is limited. Perspective from those providing PrEP in ‘real world’ settings is needed to better inform future programming, policy, and scale up. MethodsFrom September 2017 to January 2019 we conducted 54 semi-structured in-depth interviews with purposively selected healthcare workers (HCWs) from six public sector, nurse-led, primary-care clinics in Eswatini. Data from observational notes, daily debriefing sessions and interview transcripts were analyzed using Nvivo 12 following the tenets of Grounded Theory. We present our results within six domains of a modified Consolidated Framework for Implementation (CFIR). ResultsHCWs said that they adapted implementation guidelines in order to inform more people of PrEP. HCWs said that clinic and community based PrEP education and promotion was essential for demand creation, uptake and continued PrEP use. Clinic modifications included conducting PrEP risk assessments during existing TB screening services, and targeting PrEP counselling for pregnant women and clients with sexually transmitted infections. HCWs described streamlining the PrEP initiation process by fast-tracking at-risk clients for initiation and pill collection. HCW said they emphasised PrEP as being for ‘everyone’ to avoid stigma. ConclusionsIntegration of PrEP delivery into existing screening and treatment services may help reach those most vulnerable to HIV infection, avoid time-consuming referrals, and prevent loss of clients between different components of the care continuum. PrEP education and promotion should be both clinic and community based to ensure potential clients have enough information before reaching the clinic, prevent PrEP-associated stigma and assist in family and partner understanding of PrEP use. HCWs providing PrEP in public-sector clinics have first-hand knowledge of implementation in ‘real world’ settings in a field where policy and program implementation is largely undefined. Integrating their feedback into future programming and policy may support effective PrEP delivery in Eswatini and other high prevalence settings in Southern Africa.

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