Barriers to Accurate Blood Pressure Measurement in the Medical Office - PubMed (original) (raw)

Barriers to Accurate Blood Pressure Measurement in the Medical Office

Kevin O Hwang et al. J Prim Care Community Health. 2018 Jan-Dec.

Abstract

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.

Keywords: barriers; blood pressure; hypertension; measurement; office; qualitative.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Figure 1.

Factors affecting office blood pressure measurement process.

Similar articles

Cited by

References

    1. GBD 2013 Risk Factors Collaborators; Forouzanfar MH, Alexander L, Anderson HR, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:2287-2323. - PMC - PubMed
    1. Yoon SS, Fryar CD, Carroll MD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. Hyattsville, MD: National Center for Health Statistics; 2015. - PubMed
    1. Siu AL; US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163:778-786. - PubMed
    1. Kronish IM, Kent S, Moise N, et al. Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States. J Am Soc Hypertens. 2017;11:573-580. - PMC - PubMed
    1. Drawz PE, Ix JH. BP measurement in clinical practice: time to SPRINT to guideline-recommended protocols. J Am Soc Nephrol. 2018;29:383-388. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources