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.

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.

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 2057. Outpatient Antibiotic Stewardship “Bundles up” in Winter with Peer Comparison, URI Order Set and Education: Is It Enough to Weather the Storm?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S693-S693
Author(s):  
Okan I Akay ◽  
Rohini Dave ◽  
Amit Khosla ◽  
CherylAnn Kraska ◽  
Brian J Hopkins ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Drug Events ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Control Group ◽  
Upper Respiratory Infection ◽  
Primary Care Clinics ◽  
Ed Visits ◽  
The Impact ◽  
Order Set

Abstract Background Inappropriate antibiotic use is a growing problem in the outpatient setting. Approximately 90% of all antibiotics are prescribed in outpatient practices. Nonetheless, 30–70% of antibiotic prescriptions (ARx) are unnecessary. Outpatient antimicrobial stewardship (AS) is much needed and the best approach is unknown. We used a bundle approach to outpatient AS during the winter months, by implementing a peer comparison (PC) report, upper respiratory infection (URI) order set and broad education. Methods This is a quasi-experimental project during the period October 2018 to March 2019 (FY19) to evaluate the impact of a bundled intervention in primary care clinics at the VA Maryland Health Care System. A historical control group from the same period the previous year (FY18) was used for comparison. The intervention included an AS directed didactic and URI order set followed by an email in 1/2019 with: (1) censored PC report (ARx/1,000 encounters) with outliers defined as above 1.5 × interquartile range, (2) URI order set reminder, and (3) education. The primary outcome was total ARx per 1,000 encounters in primary care clinics. A random sampling of 200 charts was done to compare proportion of antibiotic appropriateness and number of emergency department (ED) visits and adverse drug events (ADEs) in FY19 Q1 and FY19 Q2. Poisson regression was carried out, in addition to Χ2-statistic. Results There were 3,799 vs. 3,429 ARx in FY18 and FY19, respectively, with a rate difference of 3.3 ARx per 1,000 encounters (P = 0.0056). Q1 to Q2 ARx rate increased by 7.8 and 8.0 ARx per 1,000 encounters in FY18 and FY19, respectively. Forty-eight percent (28/58) of the providers confirmed receipt of email. There were 3 and 4 outliers in FY19 Q1 and Q2, respectively. Appropriate ARx for FY19 Q1 and Q2 was found to be 45% and 35% (P = 0.44), respectively. The most common indications were URI (18% vs. 18%), urinary tract infection (13% vs. 21%). ED visits (10% vs. 6%) were uncommon and there were no ADEs. Conclusion E-mail communication with bundled approach had no effect on ARx or antibiotic appropriateness; however general AS presence and URI order set tempered some use. Removing peer censoring, providing face-to-face education and intensifying antibiotic order sets are additional interventions to be implemented. Disclosures All authors: No reported disclosures.

scholarly journals Measurement of Pulse Wave Signals and Blood Pressure by a Plastic Optical Fiber FBG Sensor

Sensors ◽  
2019 ◽  
Vol 19 (23) ◽  
pp. 5088 ◽  
Author(s):  
Yuki Haseda ◽  
Julien Bonefacino ◽  
Hwa-Yaw Tam ◽  
Shun Chino ◽  
Shouhei Koyama ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Optical Fiber ◽  
Calibration Curve ◽  
Pulse Wave ◽  
Blood Pressure Measurement ◽  
Plastic Optical Fiber ◽  
Fbg Sensor ◽  
Wide Range ◽  
Silica Optical Fiber ◽  
Fbg Sensors

Fiber Bragg grating (FBG) sensors fabricated in silica optical fiber (Silica-FBG) have been used to measure the strain of human arteries as pulse wave signals. A variety of vital signs including blood pressure can be derived from these signals. However, silica optical fiber presents a safety risk because it is easily fractured. In this research, an FBG sensor fabricated in plastic optical fiber (POF-FBG) was employed to resolve this problem. Pulse wave signals were measured by POF-FBG and silica-FBG sensors for four subjects. After signal processing, a calibration curve was constructed by partial least squares regression, then blood pressure was calculated from the calibration curve. As a result, the POF-FBG sensor could measure the pulse wave signals with an signal to noise (SN) ratio at least eight times higher than the silica-FBG sensor. Further, the measured signals were substantially similar to those of an acceleration plethysmograph (APG). Blood pressure is measured with low error, but the POF-FBG APG correlation is distributed from 0.54 to 0.72, which is not as high as desired. Based on these results, pulse wave signals should be measured under a wide range of reference blood pressures to confirm the reliability of blood pressure measurement uses POF-FBG sensors.

Use of unattended automated office blood pressure in Utah primary care clinics

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
John Stuligross ◽  
Taylor H. Hoj ◽  
Brittany Brown ◽  
Sarah Woolsey ◽  
Barry Stults
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Office Blood Pressure ◽  
Primary Care Clinics ◽  
Automated Office Blood Pressure
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