INCREASING HOME BLOOD PRESSURE MONITORING

Abstract

Problem: Uncontrolled blood pressure (BP) increases the risk of cardiovascular disease and mortality. Home Blood Pressure Monitoring (HBPM) is an effective strategy for controlling BP; however, only 38.7% of patients with high BP engage in HBPM. In primary care settings, the lack of measures that support HBPM is a critical barrier to performing HBPM. This project was implemented at an urban primary care clinic; approximately 90% of patients have high BP, 40% have uncontrolled BP, and only 10% perform HBPM. Patients are encouraged to practice HBPM to control BP, but the clinic does not implement measures to support HBPM. Purpose: This is a quality improvement project aimed to increase HBPM performance among patients diagnosed with high blood pressure. Method: An HBPM performance incentive policy was implemented at an urban primary care clinic. The policy required all patients diagnosed with high BP to receive a physician's prescription for a home BP device and a list of recommended home BP devices and costs. In addition, patients with insurance qualified at a local pharmacy had their prescriptions sent to the pharmacy to purchase new devices. Patients were also requested to bring their home BP devices to the clinic for validation, either new or currently used. Weekly data audits included the number of home BP devices purchased and the number of validated home BP devices. HBPM performance was measured by the percentage of the number of home BP devices purchased over the total number of patients without devices. Results: The baseline HBPM performance improved from 10% to 27.3%. There were eighteen participants, seven with used devices, eleven without devices and four with eligible insurance at the local pharmacy. Eleven patients without a device received a prescription and a list of recommended devices and costs. Four patients with eligible insurance had their prescriptions sent to the local pharmacy. Three patients received new devices. Ten patients with new and used devices received callbacks. Five devices were validated. Conclusion: The findings of this project are consistent with previous research claiming that HBPM-friendly programs and policies promote HBPM performance in hypertensive patients.