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Campbell HE, Chappell LC, McManus RJ, Tucker KL, Crawford C, Green M, Rivero-Arias O. Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials. Hypertension 2024; 81:887-896. [PMID: 38258566 PMCID: PMC10956677 DOI: 10.1161/hypertensionaha.123.22059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses. METHODS Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately. RESULTS In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2. CONCLUSIONS SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.
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Affiliation(s)
- Helen E. Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health (H.E.C., O.R.-A.)
| | - Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, United Kingdom (L.C.C.)
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences. University of Oxford, United Kingdom (R.J.M., K.L.T., C.C.)
| | - Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences. University of Oxford, United Kingdom (R.J.M., K.L.T., C.C.)
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences. University of Oxford, United Kingdom (R.J.M., K.L.T., C.C.)
| | - Marcus Green
- Action on Pre-eclampsia, Evesham, United Kingdom (M.G.)
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health (H.E.C., O.R.-A.)
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Damen LJ, Van Tuyl LHD, Korevaar JC, Knottnerus BJ, De Jong JD. Citizens' perspectives on relocating care: a scoping review. BMC Health Serv Res 2024; 24:202. [PMID: 38355575 PMCID: PMC10868012 DOI: 10.1186/s12913-024-10671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Healthcare systems around the world are facing large challenges. There are increasing demands and costs while at the same time a diminishing health workforce. Without reform, healthcare systems are unsustainable. Relocating care, for example, from hospitals to sites closer to patients' homes, is expected to make a key contribution to keeping healthcare sustainable. Given the significant impact of this initiative on citizens, we conducted a scoping review to provide insight into the factors that influence citizens' attitudes towards relocating care. METHOD A scoping review was conducted. The search was performed in the following databases: Pubmed, Embase, Cinahl, and Scopus. Articles had to include relocating healthcare and citizens' perspectives on this topic and the articles had to be about a European country with a strong primary care system. After applying the inclusion and exclusion criteria, 70 articles remained. RESULTS Factors positively influencing citizens' attitudes towards relocating care included: convenience, familiarity, accessibility, patients having more control over their disease, and privacy. Factors influencing negative attitudes included: concerns about the quality of care, familiarity, the lack of physical examination, contact with others, convenience, and privacy. Furthermore, in general, most citizens preferred to relocate care in the studies we found, especially from the hospital to care provided at home. CONCLUSION Several factors influencing the attitude of citizens towards relocating care were found. These factors are very important when determining citizens' preferences for the location of their healthcare. The majority of studies in this review reported that citizens are in favour of relocating care. In general citizens' perspectives on relocating care are very often missing in articles. It was significant that very few studies on relocation from the hospital to the general practitioner were identified.
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Affiliation(s)
- L J Damen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | - L H D Van Tuyl
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J C Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | - B J Knottnerus
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J D De Jong
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, Maastricht, the Netherlands
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Green BB, Anderson ML, McClure JB, Ehrlich K, Hall YN, Hansell L, Hsu C, Margolis KL, Munson SA, Thompson MJ. Is Hypertension Diagnostic Testing and Diagnosis Associated With Psychological Distress? Am J Hypertens 2024; 37:69-76. [PMID: 37688515 DOI: 10.1093/ajh/hpad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Psychological impacts of hypertension diagnostic testing and new hypertension diagnoses are unclear. METHODS BP-CHECK was a randomized diagnostic study conducted in 2017-2019 in an integrated healthcare system. Participants with no hypertension diagnosis or medications and elevated blood pressure (BP) were randomized to one of three diagnostic regimens: (i) Clinic, (ii) Home, or (iii) Kiosk. Participants completed questionnaires at baseline, after completion of the diagnostic regimens, and at 6 months. Outcomes included changes from baseline in health-related quality of life (HRQOL), BP-related worry, and thoughts about having a stroke or heart attack. RESULTS Participants (n = 482) were mostly over age 50 (77.0%), and White race (80.3%). HRQOL did not significantly change from baseline to 3 weeks or 6 months. Among all participants, BP-related worry and concerns about having a heart attack or stroke increased significantly from baseline to 3 weeks, with heart attack and stroke concerns significantly higher in the Kiosk compared Clinic and Home groups. At 6 months, thoughts about having a heart attack or stroke returned to baseline overall and in the Kiosk group, however BP-related worry was significantly higher among those with, compared to those without, a new hypertension diagnosis. CONCLUSIONS The hypertension diagnostic process did not lead to short-term or intermediate-term changes in self-reported HRQOL. However, BP-related worry increased short-term and persisted at 6 months among individuals with a new hypertension diagnosis. Results warrant validation in more representative populations and additional exploration of the impacts of this worry on psychological well-being and hypertension control. CLINICALTRIALS.GOV IDENTIFIER NCT03130257.
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Affiliation(s)
- B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Washington Permanente Medical Group, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - M L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - J B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - K Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Y N Hall
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - L Hansell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - C Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - S A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - M J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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4
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Thompson MJ, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Hsu C, Margolis KL, McClure JB, Munson SA, Green BB. Acceptability and Adherence to Home, Kiosk, and Clinic Blood Pressure Measurement Compared to 24-H Ambulatory Monitoring. J Gen Intern Med 2023; 38:1854-1861. [PMID: 36650328 PMCID: PMC9845022 DOI: 10.1007/s11606-023-08036-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The US Preventive Services Task Force recommends measuring blood pressure (BP) outside of clinic/office settings. While various options are available, including home devices, BP kiosks, and 24-h ambulatory BP monitoring (ABPM), understanding patient acceptability and adherence is a critical factor for implementation. OBJECTIVE To compare the acceptability and adherence of clinic, home, kiosk, and ABPM measurement. DESIGN Comparative diagnostic accuracy study which randomized adults to one of three BP measurement arms: clinic, home, and kiosk. ABPM was conducted on all participants. PARTICIPANTS Adults (18-85 years) receiving care at 12 Kaiser Permanente Washington primary care clinics (Washington State, USA) with a high BP (≥ 138 mmHg systolic or ≥ 88 mmHg diastolic) in the electronic health record with no hypertension diagnosis and on no hypertensive medications and with high BP at a research screening visit. MEASURES Patient acceptability was measured using a validated survey which was used to calculate an overall acceptability score (range 1-7) at baseline, after completing their assigned BP measurement intervention, and after completing ABPM. Adherence was defined based on the pre-specified number of BP measurements completed. KEY RESULTS Five hundred ten participants were randomized (mean age 59 years), with mean BP of 150/88. Overall acceptability score was highest (i.e. most acceptable) for Home BP (mean 6.2, SD 0.7) and lowest (least acceptable) for ABPM (mean 5.0, SD 1.0); scores were intermediate for Clinic (5.5, SD 1.1) and Kiosk (5.4, SD 1.0). Adherence was higher for Home (154/170, 90.6%) and Clinic (150/172, 87.2%) than for Kiosk (114/168, 67.9%)). The majority of participants (467/510, 91.6%) were adherent to ABPM. CONCLUSIONS Participants found home BP measurement most acceptable followed by clinic, BP kiosks, and ABPM. Our findings, coupled with recent evidence regarding the accuracy of home BP measurement, further support the routine use of home-based BP measurement in primary care practice in the US. TRIAL REGISTRATION ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
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Affiliation(s)
- Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Yoshio N Hall
- Division of Nephrology, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | | | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Sean A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA.
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
- Washington Permanente Medical Group, Seattle, WA, USA.
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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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Bhanvadia SB, Brar MS, Delavar A, Tavakoli K, Saseendrakumar BR, Weinreb RN, Zangwill LM, Baxter SL. Assessing Usability of Smartwatch Digital Health Devices for Home Blood Pressure Monitoring among Glaucoma Patients. INFORMATICS (MDPI) 2022; 9:79. [PMID: 36873830 PMCID: PMC9980658 DOI: 10.3390/informatics9040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glaucoma is a leading cause of blindness worldwide. Blood pressure (BP) dysregulation is a known risk factor, and home-based BP monitoring is increasingly used, but the usability of digital health devices to measure BP among glaucoma patients is not well studied. There may be particular usability challenges among this group, given that glaucoma disproportionately affects the elderly and can cause visual impairment. Therefore, the goal of this mixed-methods study was to assess the usability of a smart watch digital health device for home BP monitoring among glaucoma patients. Adult participants were recruited and given a smartwatch blood pressure monitor for at-home use. The eHEALS questionnaire was used to determine baseline digital health literacy. After a week of use, participants assessed the usability of the BP monitor and related mobile app using the Post-study System Usability Questionnaire (PSSUQ) and the System Usability Scale (SUS), standardized instruments to measure usability in health information technology interventions. Variations in scores were evaluated using ANOVA and open-ended responses about participants' experience were analyzed thematically. Overall, usability scores corresponded to the 80th-84th percentile, although older patients endorsed significantly worse usability based on quantitative scores and additionally provided qualitative feedback describing some difficulty using the device. Usability for older patients should be considered in the design of digital health devices for glaucoma given their disproportionate burden of disease and challenges in navigating digital health technologies, although the overall high usability scores for the device demonstrates promise for future clinical applications in glaucoma risk stratification.
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Affiliation(s)
- Sonali B. Bhanvadia
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Manreet S. Brar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Arash Delavar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Kiana Tavakoli
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
| | - Sally L. Baxter
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
- Correspondence: ; Tel.: +1-(858)-246-4604
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Railey AF, Dillard DA, Fyfe-Johnson A, Todd M, Schaefer K, Rosenman R. Choice of home blood pressure monitoring device: the role of device characteristics among Alaska Native and American Indian peoples. BMC Cardiovasc Disord 2022; 22:19. [PMID: 35090399 PMCID: PMC8796453 DOI: 10.1186/s12872-021-02449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring (HBPM) is an effective tool in treatment and long-term management of hypertension. HBPM incorporates more data points to help patients and providers with diagnosis and management. The characteristics of HBPM devices matter to patients, but the relative importance of the characteristics in choosing a device remains unclear. METHODS We used data from a randomized cross-over pilot study with 100 Alaska Native and American Indian (ANAI) people with hypertension to assess the choice of a wrist or arm HBPM device. We use a random utility framework to evaluate the relationship between stated likely use, perceived accuracy, ease of use, comfort, and participant characteristics with choice of device. Additional analyses examined willingness to change to a more accurate device. RESULTS Participants ranked the wrist device higher compared to the arm on a 5-point Likert scale for likely use, ease of use, and comfort (0.3, 0.5, 0.8 percentage points, respectively). Most participants (66%) choose the wrist device. Likely use (wrist and arm devices) was related to the probability of choosing the wrist (0.7 and - 1.4 percentage points, respectively). Independent of characteristics, 75% of participants would be willing to use the more accurate device. Ease of use (wrist device) and comfort (arm device) were associated with the probability of changing to a more accurate device (- 1.1 and 0.5 percentage points, respectively). CONCLUSION Usability, including comfort, ease, and likely use, appeared to discount the relative importance of perceived accuracy in the device choice. Our results contribute evidence that ANAI populations value accurate HBPM, but that the devices should also be easy to use and comfortable to facilitate long-term management.
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Affiliation(s)
- Ashley F Railey
- Department of Sociology, Indiana University, Bloomington, IN, USA.
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA.
| | | | - Amber Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | | | | | - Robert Rosenman
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
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8
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Guirguis-Blake JM, Evans CV, Webber EM, Coppola EL, Perdue LA, Weyrich MS. Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1657-1669. [PMID: 33904862 DOI: 10.1001/jama.2020.21669] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Hypertension is a major risk factor for cardiovascular disease and can be modified through lifestyle and pharmacological interventions to reduce cardiovascular events and mortality. OBJECTIVE To systematically review the benefits and harms of screening and confirmatory blood pressure measurements in adults, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, Cochrane Collaboration Central Registry of Controlled Trials, and CINAHL; surveillance through March 26, 2021. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies for effectiveness of screening; accuracy studies for screening and confirmatory measurements (ambulatory blood pressure monitoring as the reference standard); RCTs and nonrandomized controlled intervention studies and observational studies for harms of screening and confirmation. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; meta-analyses and qualitative syntheses. MAIN OUTCOMES AND MEASURES Mortality; cardiovascular events; quality of life; sensitivity, specificity, positive and negative predictive values; harms of screening. RESULTS A total of 52 studies (N = 215 534) were identified in this systematic review. One cluster RCT (n = 140 642) of a multicomponent intervention including hypertension screening reported fewer annual cardiovascular-related hospital admissions for cardiovascular disease in the intervention group compared with the control group (difference, 3.02 per 1000 people; rate ratio, 0.91 [95% CI, 0.86-0.97]). Meta-analysis of 15 studies (n = 11 309) of initial office-based blood pressure screening showed a pooled sensitivity of 0.54 (95% CI, 0.37-0.70) and specificity of 0.90 (95% CI, 0.84-0.95), with considerable clinical and statistical heterogeneity. Eighteen studies (n = 57 128) of various confirmatory blood pressure measurement modalities were heterogeneous. Meta-analysis of 8 office-based confirmation studies (n = 53 183) showed a pooled sensitivity of 0.80 (95% CI, 0.68-0.88) and specificity of 0.55 (95% CI, 0.42-0.66). Meta-analysis of 4 home-based confirmation studies (n = 1001) showed a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a specificity of 0.60 (95% CI, 0.48-0.71). Thirteen studies (n = 5150) suggested that screening was associated with no decrement in quality of life or psychological distress; evidence on absenteeism was mixed. Ambulatory blood pressure measurement was associated with temporary sleep disturbance and bruising. CONCLUSIONS AND RELEVANCE Screening using office-based blood pressure measurement had major accuracy limitations, including misdiagnosis; however, direct harms of measurement were minimal. Research is needed to determine optimal screening and confirmatory algorithms for clinical practice.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Department of Family Medicine, University of Washington, Tacoma
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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9
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Ringrose JS, Bapuji R, Coutinho W, Mouhammed O, Bridgland L, Carpenter T, Padwal R. Patient perceptions of ambulatory blood pressure monitoring testing, tolerability, accessibility, and expense. J Clin Hypertens (Greenwich) 2019; 22:16-20. [PMID: 31816184 DOI: 10.1111/jch.13760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/05/2019] [Accepted: 11/17/2019] [Indexed: 11/26/2022]
Abstract
Use of 24-hour ambulatory blood pressure monitoring is strongly endorsed by contemporary hypertension guidelines. The objective of this study was to assess patient perceptions of ambulatory blood pressure testing, tolerability, accessibility, and expense. A convenience sample of 50, consenting patients undergoing ambulatory blood pressure monitoring at the University of Alberta Hypertension Clinic in Edmonton, Canada was studied. A 16-item structured questionnaire was administered in person or electronically. Questions regarding the tolerability of ambulatory monitoring were evaluated using a 5-point Likert scale and wait times, expenditures, and willingness to pay were evaluated by direct questioning. Mean age was 53.1 ± 15.4 years, 32 (64%) were female, and 23 (46%) were employed. Mean 24-hour ambulatory BP was 134 ± 12/79 ± 8 mmHg. Ambulatory monitoring caused discomfort in 40 (80%) patients and disturbed sleep in 39 (78%). Forty-one (82%) patients perceived that the home (vs pharmacy, primary care clinic, and speciality care clinic) would be the easiest venue to access future testing. On average, patients waited 27.3 ± 23.7 days for testing; they felt that a wait time of 21.3 ± 12.3 days was appropriate. Mean time taken off work was 8.6 ± 10.8 hours. Twelve (24%) patients indicated that they would be willing to pay out-of-pocket to undergo testing sooner, at a mean expenditure of $120 ± 69. Nineteen (62%) patients were willing to buy a monitor and felt that a mean purchase cost of $125 ± 89 was appropriate. These findings extend current knowledge of patient perceptions of ambulatory monitoring and may help to refine and optimize future delivery of this essential test.
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Affiliation(s)
- Jennifer S Ringrose
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Women and Children's Health Research Institute, Edmonton, AB, Canada
| | - Raj Bapuji
- Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Wade Coutinho
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Omar Mouhammed
- Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | | | - Thirza Carpenter
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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