Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?

Home Blood Pressure Measurements Are Not Performed According to Guidelines and Standardized Education Is Urgently Needed

BACKGROUND

Patient education is needed to perform home blood pressure measurement (HBPM) according to blood pressure (BP) guidelines. It is not known how BP is measured at home and what education is provided, which was the aim of the study.

METHODS

Mixed-methods study among Australian adults who perform HBPM (June to December 2023). Participants completed a 30-item online survey on whether they followed guideline recommendations and the education they received for HBPM. Phone interviews were conducted among a purposive sample to further explore survey topics.

RESULTS

Participants (n=350) were middle-aged (58±16 years; 54% women), and most (n=250, 71%) had hypertension. Guideline recommendations for HBPM were not always followed by survey participants. Most participants measured BP seated (n=316, 90%) with the cuff fitted to a bare arm (n=269, 77%). Only 15% measured BP in the morning and evening (n=54) and 26% averaged the BP readings over 7 days (n=90). Interview participants (n=34) described measuring BP at "different times of the day after doing different things." One-third of participants (n=112, 37%) received education for HBPM, which interview participants described as vague verbal instructions from health care practitioners. Participants who received education did not perform high-quality HBPM. Participants who did not receive education mimicked BP measurement methods of health care practitioners, "I do it the way I've seen them do it."

CONCLUSIONS

HBPM is not performed according to guideline recommendations, and adults who received ad hoc education did not perform high-quality HBPM. These findings highlight a need for effective education to support HBPM for clinical decision-making.

Current practices and knowledge of home blood pressure monitoring among people with hypertension: Insights from a Multicentric study from North India

OBJECTIVES

Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context.

METHODS

The current study was conducted across three North Indian centres to evaluate the prevalence, training and technique of HBPM among people with HTN and their caregivers. People with diagnosed HTN (>3 months duration) and their caregivers, were screened and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on the most recent AHA guidelines. Responses were graded and classified based on quartiles.

RESULTS

A total of 2750 participants were screened, of which 2588 (2070 from urban and 518 from rural areas) were included. A total of 468 (18.1 %) were using HBPM. The proportion of respondents using HBPM was 20.5 % (424/2070) in urban, and 8.5 % (44/518) in rural areas. Only 24.7 % (n = 116) of the 468 participants (236 patients and 232 caregivers) using HBPM at home recalled ever receiving training from any healthcare workers. The majority (75.2 %, 352/468) of participants reported learning HBPM themselves through observation, videos, and reading. In HBPM practice assessment, 15.9 % of people with HTN (37/232) vs 5.9 % caregivers (14/236) scored excellent (score >75 %). In HPBM knowledge assessment, 0.4 % of people with HTN (1/232) vs no caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1 % and 40.1 ± 16.2 % respectively. Higher education level was associated with improved patient knowledge (p = 0.041), but not practices (p = 0.225).

CONCLUSIONS

There is need for more robust training on HBPM to enable people from all backgrounds to better manage their HTN, especially in rural areas. Education is not a barrier to learning good HBPM technique.

Comparing ChatGPT and Bing, in response to the Home Blood Pressure Monitoring (HBPM) knowledge checklist

High blood pressure is one of the major public health problems that is prevalent worldwide. Due to the rapid increase in the number of users of artificial intelligence tools such as ChatGPT and Bing, it is expected that patients will use these tools as a source of information to obtain information about high blood pressure. The purpose of this study is to check the accuracy, completeness, and reproducibility of answers provided by ChatGPT and Bing to the knowledge questionnaire of blood pressure control at home. In this study, ChatGPT and Bing's responses to the HBPM 10-question knowledge checklist on blood pressure measurement were independently reviewed by three cardiologists. The mean accuracy rating of ChatGPT was 5.96 (SD = 0.17) indicating the responses were highly accurate overall, with the vast majority receiving the top score. The mean accuracy and completeness of ChatGPT were 5.96 (SD = 0.17) and 2.93 (SD = 0.25) and in Bing were 5.31 (SD = 0.67), and 2.13 (SD = 0.53) Respectively. Due to the expansion of artificial intelligence applications, patients can use new tools such as ChatGPT and Bing to search for information and at the same time can trust the information obtained. we found that the answers obtained from ChatGPT are reliable and valuable for patients, while Bing is also considered a powerful tool, it has more limitations than ChatGPT, and the answers should be interpreted with caution.

Exploring primary care physicians' challenges in using home blood pressure monitoring to manage hypertension in Singapore: a qualitative study

Objective

Hypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension.

Method

A qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis.

Results

PCPs identified variations in patients' HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult.

Conclusion

Despite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.

Characteristics of self-management education and support programmes for people with chronic diseases delivered by primary care teams: a rapid review

BACKGROUND

Primary care actors can play a major role in developing and promoting access to Self-Management Education and Support (SMES) programmes for people with chronic disease. We reviewed studies on SMES programmes in primary care by focusing on the following dimensions: models of SMES programmes in primary care, SMES team's composition, and participants' characteristics.

METHODS

For this mixed-methods rapid review, we searched the PubMed and Cochrane Library databases to identify articles in English and French that assessed a SMES programme in primary care for four main chronic diseases (diabetes, cancer, cardiovascular disease and/or respiratory chronic disease) and published between 1 January 2013 and 31 December 2021. We excluded articles on non-original research and reviews. We evaluated the quality of the selected studies using the Mixed Methods Appraisal Tool. We reported the study results following the PRISMA guidelines.

RESULTS

We included 68 studies in the analysis. In 46/68 studies, a SMES model was described by focusing mainly on the organisational dimension (n = 24). The Chronic Care Model was the most used organisational model (n = 9). Only three studies described a multi-dimension model. In general, the SMES team was composed of two healthcare providers (mainly nurses), and partnerships with community actors were rarely reported. Participants were mainly patients with only one chronic disease. Only 20% of the described programmes took into account multimorbidity. Our rapid review focused on two databases and did not identify the SMES programme outcomes.

CONCLUSIONS

Our findings highlight the limited implication of community actors and the infrequent inclusion of multimorbidity in the SMES programmes, despite the recommendations to develop a more interdisciplinary approach in SMES programmes. This rapid review identified areas of improvement for SMES programme development in primary care, especially the privileged place of nurses in their promotion.

TRIAL REGISTRATION

PROSPERO 2021 CRD42021268290 .

Home Blood Pressure Monitoring in Women of Child-Bearing Age With Hypertension From 2009 to 2014

BACKGROUND

Hypertension (HTN) is a leading cause of maternal mortality, and HTN guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. Evidence suggests that HBPM be coupled with a care team to maximize its effectiveness. HBPM use and the prevalence of provider counseling in child-bearing age women with HTN are unknown.

METHODS

We used data from 3,614 women in the cross-sectional National Health and Nutrition Examination Surveys 2009-2014 to determine HBPM use and provider counseling for women of child-bearing age (20-50 years) with and without HTN. HBPM use and provider counseling were self-reported. We examined rates of HBPM use by race/ethnicity, poverty-income ratio (PIR), education, and insurance.

RESULTS

Among women of child-bearing age with HTN, the mean (SE) age was 37.0 (0.3) years, the mean (SE) BMI was 35.5 (0.6) kg/m2, and 73% were on BP medication. Of these women with HTN, 49.6% reported HBPM use in the past year and 40.4% received provider counseling. There was no significant difference in HBPM use by race/ethnicity, PIR, or insurance, though higher education was associated with HBPM use. Women with HTN who received provider counseling were more likely to use HBPM (odds ratio = 15.7, 95% confidence interval 9.1-26.9).

CONCLUSIONS

Nearly half of child-bearing age women with HTN have adopted HBPM, and provider counseling was strongly associated with HBPM use. This highlights a need and opportunity for providers to improve BP management by supporting a popular and valuable monitoring approach among women of child-bearing age with HTN.