Article Figures & Data
Figures
- Figure 1.
Flow chart for home blood pressure (BP) implementation. HTN, hypertension; AOBP, Automated office blood pressure; HBPM, home blood pressure measurement.
Tables
- Table 1.
Characteristics of Clinic Patients with Elevated Blood Pressure, Both Enrolled and Not Enrolled in BP Monitoring Program
Patient Characteristic Enrolled (n = 183) Not Enrolled (n = 1326) Mean age, years (SD) 59.7 (15.8) 61.0 (15.9) Sex, n, (% male) 103 (56) 701 (53) Race, n, (% white) 164 (90) 1145 (86) Insurance type, (n % commercial) 96 (52) 620 (47) Comorbid medical conditions Diabetes, n (%) 36 (20) 326 (25) Cardiovascular disease, n (%) 47 (26) 424 (32) Hyperlipidemia, n (%) 95 (52) 757 (57) Chronic kidney disease*, n (%) 17 (9) 160 (12) Hypertension diagnosis in EHR, n (%) 119 (65) 919 (69) Median number of BP medications (25th percentile, 75th percentile) 2.0 (1.0, 2.0) 2.0 (1.0, 2.0) Median baseline SBP (25th percentile, 75th percentile) 145.0 (138.0, 154.0) 144 (140.0, 152.0) Median baseline DBP (25th percentile, 75th percentile) 91.0 (85.0, 96.0) 90.0 (81.0, 94.0) ↵* Patients with ESRD were excluded from BP monitoring program.
SD, standard deviation; BP, blood pressure; EHR, electronic health record; SBP, systolic blood pressure; DBP, diastolic blood pressure; ESRD, end stage renal disease.
- Table 2A.
Diagnoses of Patients Not Initially on Medications after Initial HBPM Results Received, Stratified by Office Blood Pressure Technique (n = 84)
Diagnosis Method of OBPM AOBP ≥ 135/85 (n = 42) Observed Average of 3 BP ≥ 135/85 (n = 19) Single Observed BP ≥ 140/90 (n = 23) New HTN, n (%) 22 (52) 12 (63) 11 (48) White coat HTN, n (%) 14 (33) 4 (21) 11 (48) Diagnosis unknown (no initial HBPM received), n (%) 6 (14) 3 (16) 1 (4) Fisher's exact test was used to determine whether the proportion of diagnoses differed by OBPM technique (P = .39).
AOBP, automated office blood pressure; BP, blood pressure; HBPM, home blood pressure measurement; OBPM, office blood pressure measurement; HTN, hypertension.
- Table 2B.
Diagnoses of Patients Initially on Medications after Initial and Final HBPM Results Received, Stratified by Office Blood Pressure Technique (n = 99)
Diagnosis Method of OBPM AOBP ≥ 135/85 (n = 48) Observed Average of 3 BP ≥ 135/85 (n = 21) Single Observed BP ≥ 140/90 (n = 30) Existing uncontrolled HTN, n (%) 21 (44) 15 (71) 17 (57) White-coat BP elevation, n (%) 20 (42) 5 (24) 12 (40) Unknown (no initial HBPM received), n (%) 7 (14) 1 (5) 1 (3) Fisher's exact test was used to determine whether the proportion of diagnoses differed by OBPM technique (P = .19).
AOBP, automated office blood pressure; BP, blood pressure; HBPM, home blood pressure measurement; OBPM, office blood pressure measurement; HTN, hypertension.
Estimated Time Required (minutes) Unobserved* AOBP measurement 4 Patient training for HBPM 10 HBPM device accuracy assessment 10 EHR documentation of AOBP/HBPM data 2 Transmission of HBPM data to clinician 2 ↵* MAs could attend to other duties at this time.
AOBP, automated office blood pressure measurement; EHR, electronic health record; HBPM, home blood pressure measurement.
MA Nurse/Pharmacist Resident Physician Attending Physician Other 4 2 10 2 1 Question Total Strongly Agree Agree Neither Disagree Strongly Disagree I Don't Know Project lowered BP and positively affected BP management, n (%) 19 5 (26.3) 8 (42.1) 2 (10.5) 0 (0.0) 0 (0.0) 4 (21.1) Project improved patient engagement, n (%) 19 7 (36.8) 7 (36.8) 11 (57.9) 0 (0.0) 0 (0.0) 1 (5.3) Project requirement excessive effort form me, n (%) 19 1 (5.3) 2 (10.5) 3 (15.8) 11 (57.9) 2 (10.5) X Feel adequately trained, n (%) 19 5 (26.3) 11 (57.9) 3 (15.8) 0 (0.0) 0 (0.0) X Plan to continue educating pts, n (%) 19 9 (47.4) 10 (52.6) 0 (0.0) 0 (0.0) 0 (0.0) X Question Total Very Positive Positive Neutral Negative Very Negative Impression of project to improve BP, n (%) 19 8 (42.1) 9 (47.4) 2 (10.5) 0 (0.0) 0 (0.0) Question Total 1 to 15 minutes 16 to 30 minutes 31 to 45 minutes 46 to 60 minutes > 60 minutes Time spent/per pt on project, n (%) 19 17 (89.5) 0 (0.0) 2 (10.5) 0 (0.0) 0 (0.0) BP, blood pressure; MA, medical assistants.
Question Total Strongly Agree Agree Neither Disagree Strongly Disagree Participation improved BP, n (%) 56 8 (14) 17 (30) 26 (46) 4 (7) 1 (2) Helped me become more involved in BP care, n (%) 55 17 (31) 29 (53) 6 (11) 2 (4) 1 (2) Have more confidence in measuring BP, n (%) 54 17 (31) 28 (52) 7 (13) 1 (2) 1 (2) Staff replied in timely manner, n (%) 53 17 (32) 27 (51) 9 (17) 0 (0) 0 (0) Easy to follow instructions to check BP, n (%) 54 22 (41) 27 (50) 2 (4) 3 (6) 0 (0) Question Total <15 Minutes 16 to 30 Minutes 31 to 60 Minutes >60 Minutes Time/day measuring BP, n (%) 54 34 (63) 18 (33) 2 (4) 0 (0) Question Total Very Positive Positive Neutral Negative Very Negative Overall impression of project, n (%) 53 26 (49) 20 (38) 7 (13) 0 (0) 0 (0) Question Total 1 to 25 26 to 50 51 to 75 76 to 100 Already Have Not Willing to Buy Would be willing to spend $X on BP monitor, n (%) 56 5 (9) 13 (23) 8 (14) 4 (7) 22 (39) 4 (7) Question Total Yes No Plan to continue home BP monitoring, n (%) 54 40 (74) 14 (26) BP, blood pressure.
