Feasibility and acceptability of using ABPM to manage hypertension in primary care: a qualitative study

INTRODUCTION: Ambulatory Blood Pressure Monitoring (ABPM) offers advantages over conventional methods in hypertension diagnosis and monitoring; however, it is underutilised in primary care. This study explores the feasibility and acceptability of ABPM among primary care providers (PCPs) in Singapore. METHODS: The study used a qualitative research design. Between August 2022 to January 2024, eleven primary care physicians (PCPs) from two public primary care clinics in the Eastern region of Singapore were interviewed using a semi-structured topic guide through focus group discussions and in-depth interviews. The audio-recorded interviews were transcribed verbatim before thematic analysis. RESULTS: Three main themes emerged: utility of ABPM, challenges to implementing ABPM, and utility and usability of the ABPM reports. PCPs recognised the value of ABPM in optimising hypertension management in primary care, particularly in addressing diagnostic dilemmas, guiding medication titration, and facilitating patient counselling. They also emphasised the importance of a user-friendly ABPM report to support clinical decision-making. However, implementation challenges were identified, including challenges in explaining ABPM to patients due to limited time and resources, unfamiliarity with its workflow and uncertainty in follow-up action for ABPM reported hypertension phenotypes. Additionally, some PCPs stressed that ABPM should be applied selectively and is not appropriate for all patients with hypertension. CONCLUSION: While PCPs recognised the benefits of ABPM for accurate hypertension diagnosis and clinical decision-making, significant barriers remain. Addressing concerns about limited time, resources, and workflow integration is crucial for the broader adoption of ABPM in primary care settings. While user-friendly reports are preferred, careful attention to their design and presentation is essential.