What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=16). Intervention: Out-of-office blood pressure monitoring. Primary outcome: Acceptance and use of out-of-office blood pressure monitoring.

October 1, 2015Open Access

Implementation of Out-of-Office Blood Pressure Monitoring in the Netherlands

Key Result

Physicians' strong preference for 24-hour ambulatory blood pressure monitoring over home monitoring impeded the diffusion and patient adoption of home blood pressure monitoring in the Netherlands.

Study Design

Type

Observational (n=16)

Structured PICO

Population

16 participants, comprising 12 hypertensive patients and 4 general practitioners in the Netherlands, participated in focus group discussions regarding out-of-office blood pressure monitoring.

Exposure

Out-of-office blood pressure monitoring (24-hour ambulatory blood pressure measurement [ABPM] and home BP measurement [HBPM])

Outcome

Acceptance and use of out-of-office BP monitoring methods (ABPM and HBPM) among patients and physicians

In the Netherlands, physician preference for ABPM over HBPM drives patient use and limits the adoption of home blood pressure monitoring, highlighting the impact of provider attitudes on self-management.

Limitations

Small sample size with only 16 participants across 4 focus groups
Inability to recruit patients or physicians with experience using home blood pressure monitoring (HBPM)
Potential selection bias as participants were volunteers who might be more positive about out-of-office monitoring
Findings from a qualitative study in a specific region may not be generalizable to the wider population of the Netherlands

Abstract

Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients' and physicians' acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients' feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients' self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients' acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that physicians' positive attitude to ABPM enabled the use of the method by patients which, in turn, impeded the diffusion of HBPM. For patients, the acceptance process of HBPM can only begin after the physician has adopted the innovation. Physicians are in a position to encourage as well as hinder out-of-office BP monitoring and self-management.

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