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Zhang L, Liang H, Luo H, He W, Cai Y, Liu S, Fan Y, Huang W, Zhao Q, Zhong D, Li J, Lv S, Li C, Xie Y, Zhang N, Xu D(R. Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100973. [PMID: 38076324 PMCID: PMC10701131 DOI: 10.1016/j.lanwpc.2023.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/15/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
Background This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices. Methods We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary care, and deployed trained SPs for unannounced visits to randomly selected providers in seven provinces of China. The SPs used a checklist based on guidelines to record whether and how blood pressure was measured. Data were analyzed descriptively and regression analysis was performed to examine the association between outcomes and factors such as provider, patient, facility, and clinical case characteristics. Findings The SPs conducted 1201 visits and found that less than one-third of USPs ≥35 had their blood pressure measured. Only 26.9% of migraine and 15.4% of diabetes cases received blood pressure measurements. Additionally, these measurements did not follow the proper guidelines and recommended steps. On average, 55.6% of the steps were followed with few providers considering influencing factors before measurement and only 6.0% of patients received both-arm measurements. The use of wrist sphygmomanometers was associated with poor blood pressure measurement. Interpretation In China, primary care hypertension screening practices fall short of guidelines, with infrequent initiation of blood pressure measurements and inadequate adherence to proper measurement steps. To address this, priority should be placed on adopting, implementing, and upholding guidelines for hypertension screening and measurement. Funding National Natural Science Foundation of China, Swiss Agency for Development and Cooperation, Doctoral Fund Project of Inner Mongolia Medical University, China Postdoctoral Science Foundation.
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Affiliation(s)
- Lanping Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- The Third Department of Lung Disease, Shenzhen Third People's Hospital, Shenzhen, Guangdong Province 518112, China
| | - Huijuan Liang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Huanyuan Luo
- Acacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenjun He
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yiyuan Cai
- Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou Province, China
| | - Siyuan Liu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Wenxiu Huang
- Erfenzi Township Health Center of Wuchuan County, Inner Mongolia, China
| | - Qing Zhao
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
| | - Dongmei Zhong
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jiaqi Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Chunping Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yunyun Xie
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Dong (Roman) Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
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Elzeky MEH, Shahine NFM. Effects of an educational program using a virtual social network on nurses' knowledge and performance of blood pressure measurement: a randomized controlled trial. BMC Nurs 2022; 21:365. [PMID: 36544166 PMCID: PMC9769047 DOI: 10.1186/s12912-022-01137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypertension diagnosis, treatment, and follow-up depend on accurate blood pressure measurement; however, inaccurate measurement techniques are common among healthcare providers. To improve professional performance, continuous education is necessary. Distance education through virtual social network can be used as it is easy to use and accessible. METHODS This study adopted a randomized controlled trial design and was conducted at two hospitals in Mansoura, Egypt. The subjects were selected from two hospitals using Stratified random sampling method in proportion to the total number of nurses. Seventy nurses were included in this study and were randomly divided into the intervention (n = 35) and control (n = 35) groups using block randomization. Data were gathered before and after intervention using a blood pressure measurement knowledge questionnaire and a blood pressure measurement observation checklist. The blood pressure measurement error (the difference between the BP determined by each observer and the reference BP) was calculated for the randomly selected recordings in both groups. The intervention group received 24 blood pressure measurement education sessions using WhatsApp, while the control group received only routine education using traditional lecture. RESULTS No statistically significant differences in pretest knowledge scores, performance scores, and range of error were found between both groups, whereas, after intervention, knowledge scores were higher in the intervention group than those in the control group (p < 0.001). The range of error of systolic and diastolic blood pressure values significantly reduced after the intervention in the intervention group, and the posttest performance scores were higher than the pretest performance scores; however, the difference was not statistically significant. CONCLUSIONS The blood pressure measurement education program via WhatsApp was effective in increasing nurses' knowledge and reducing the range of error; however, a multimodal approach may be required to improve performance scores. TRIAL REGISTRATION Prospectively registered with ClinicalTrials.gov on 09/03/2021; registration number NCT04789642.
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Affiliation(s)
- Mohamed E. H. Elzeky
- grid.10251.370000000103426662Medical-Surgical Nursing Department, Faculty of Nursing, Mansoura University, Dakahlia, Egypt
| | - Noha F. M. Shahine
- grid.10251.370000000103426662Gerontological Nursing Department, Faculty of Nursing, Mansoura University, Dakahlia, Egypt
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Knowledge, perception and practice of health professionals regarding blood pressure measurement methods: a scoping review. J Hypertens 2020; 39:391-399. [PMID: 33031184 DOI: 10.1097/hjh.0000000000002663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Guideline-concordant performance of accurate blood pressure measurement (BPM), whether the modality is home (HBPM), ambulatory (ABPM), automated (AOBP) or office (OBPM), is dependent on proper technique. Knowledge, perception and practice of health professionals for BPM is crucial and has been partly studied, but a thorough review has never been reported. A scoping review of global studies was conducted to synthesize published data on this topic. METHODS An Arksey and O'Malley methodological framework was used. Keywords were identified and extraction was completed to April 2019 using CINAHL and MEDLINE. Studies were classified as positive for knowledge, perception and practice if the majority (>50%) of reported responses were favourable, and negative otherwise. If specific results were not reported, the author's conclusions were used to classified. RESULTS Seventy-two studies were identified: 25 HBPM, 14 ABPM, two AOBP, 40 OBPM. For knowledge, the percentage of negative studies were higher for HBPM (40%) and OBPM (68%) and lower for ABPM (14%) regarding BPM techniques. For perception, the number of negative studies were lower for HBPM (20%) and ABPM (7%) regarding usefulness of BPM methods in hypertension management. For practice, the number of negative studies were higher for HBPM (48%), ABPM (71%), OBPM (73%) and AOBP (50%) regarding implementation of hypertension guidelines. CONCLUSION The results of this scoping review demonstrate adequate perception of BPM but suboptimal knowledge and practice. Education is still needed to improve knowledge and practice. Future efforts should focus on improving what we know and what we do when measuring BP.
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Bachur CK, Candido SS, Silveira GB, Sousa SGO, Hercos J, Veiga EV. Improvement in Semiconductivity On The Measurement Of Blood Pressure After An Educational Intervention In Health Professionals. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Daniel ACQG, Veiga EV, Machado JP, Mafra ACCN, Cloutier L. Effect of an educational program for the knowledge and quality of blood pressure recording. Rev Lat Am Enfermagem 2019; 27:e3179. [PMID: 31596414 PMCID: PMC6781557 DOI: 10.1590/1518-8345.3011.3179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/14/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to evaluate the effect of an educational program on blood pressure recording for nursing professionals in relation to theoretical knowledge and the quality of these records. METHOD quasi-experimental study conducted in a hospital service located in the city of São Paulo. The theoretical knowledge of 101 professionals was measured using a validated questionnaire before and after the educational intervention; the quality of blood pressure records was evaluated using a validated form which was applied to 354 records in the pre-intervention period and 288 in the post-intervention period. The educational program was based on active teaching-learning methodologies and consisted of two strategies: expository/dialogue class and a board game. The Wilcoxon, Mann-Whitney, Fisher and Chi-Square tests were used for comparisons, adopting a level of significance of α=0.05. RESULTS the median of the professionals' scores increased from 19 to 22 points in the post-intervention period (p<0.001). There was an improvement in the quality of the blood pressure recordings regarding the variables: cuff size (p<0.001), arm used in the procedure (p<0.001) and patient position (p<0.001). CONCLUSION the educational program showed positive results in the promotion of knowledge among nursing professionals and in the improvement of the quality of blood pressure recording.
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Affiliation(s)
| | - Eugenia Velludo Veiga
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brasil
| | | | | | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Département de Sciences
Infirmières, Trois-Rivières, QC, Canadá
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Daniel ACQG, Machado JP, Veiga EV. Blood pressure documentation in the emergency department. EINSTEIN-SAO PAULO 2017; 15:29-33. [PMID: 28444085 PMCID: PMC5433303 DOI: 10.1590/s1679-45082017ao3737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/28/2016] [Indexed: 12/04/2022] Open
Abstract
Objective To analyze the frequency of blood pressure documentation performed by nursing professionals in an emergency department. Methods This is a cross-sectional, observational, descriptive, and analytical study, which included medical records of adult patients admitted to the observation ward of an emergency department, between March and May 2014. Data were obtained through a collection instrument divided into three parts: patient identification, triage data, and blood pressure documentation. For statistical analysis, Pearson’s correlation coefficient was used, with a significance level of α<0.05. Results One hundred fifty-seven records and 430 blood pressure measurements were analyzed with an average of three measurements per patient. Of these measures, 46.5% were abnormal. The mean time from admission to documentation of the first blood pressure measurement was 2.5 minutes, with 42 minutes between subsequent measures. There is no correlation between the systolic blood pressure values and the mean time interval between blood pressure documentations: 0.173 (p=0.031). Conclusion The present study found no correlation between frequency of blood pressure documentation and blood pressure values. The frequency of blood pressure documentation increased according to the severity of the patient and decreased during the length of stay in the emergency department.
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Affiliation(s)
| | | | - Eugenia Velludo Veiga
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Veiga EV, Daniel ACQG, Bortolloto LA, Machado CA, Plavinik FL, CláudiaIrigoyen M, Campbell N, Kenerson J, Cloutier L. Problems and Solutions in Implementing the World Hypertension League Recommendations for Automated Office Assessment of Blood Pressure. J Clin Hypertens (Greenwich) 2016; 18:7-9. [PMID: 26456385 PMCID: PMC8032036 DOI: 10.1111/jch.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eugenia V. Veiga
- General and Specialized Nursing DepartmentCollege of NursingUniversity of São PauloRibeirão PretoBrazil
| | | | - Luiz A. Bortolloto
- Hypertension Unity of the Heart Institute (InCor)Hospital das ClínicasHypertension CenterHospital Alemão Oswaldo CruzUniversity of São PauloSão PauloBrazil
| | - Carlos A. Machado
- Belém Hypertension League. Ministry of Health 1989–2013 and Cardiovascular Health Promotion of the Brazilian Society of Cardiology (from 2012 to 2013)University of São PauloSão PauloBrazil
| | - Frida L. Plavinik
- Hospital Alemão Oswaldo CruzHypertension GroupBrazilian Hypertension SocietySão PauloBrazil
| | - Maria CláudiaIrigoyen
- Heart Institute (InCor)Hospitaldas ClínicasFaculty of MedicineUniversity of São PauloSão PauloBrazil
| | - Norm Campbell
- Departments of MedicineCommunity Health Sciences and PhysiologyO'Brien Institute of Public HealthLibin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - John Kenerson
- Virginia Hypertension InstituteColleagues in CareVirginia BeachVirginia
| | - Lyne Cloutier
- Université du Québec à Trois‐RivièresTrois‐RivièresQuébecCanada
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