Abstract TH128: Home Blood Pressure Monitoring in Subspecialty Clinics: A Needs Assessment

Objectives: Home blood pressure monitoring (HBPM) distinguishes sustained hypertension from masked and white coat hypertension, and has been shown to improve blood pressure control and medication adherence. We suspected that HBPM use may be inadequate at our institution as there is no uniform mechanism for communicating or documenting HBPM. Methods: We developed a quality improvement (QI) initiative to improve uptake of and documentation of HBPM. Our aim was for 50% of patients with hypertension to be performing HBPM on ≥3 days (i.e. ≥6 readings) prior to appointments. We performed a retrospective gap analysis using chart audits to assess HBPM documentation within internal medicine, nephrology, cardiology and endocrinology visits. We also surveyed clinicians to assess current use of and barriers to HBPM. We created an Ishikawa (fishbone) diagram to outline the patient, provider, equipment and organization factors required for adequate HBPM usage. Results: We audited 10 randomly selected charts with a visit diagnosis of “hypertension” from four divisions totalling 40 visits from 17 different providers. HBPM readings were mentioned in 26 out of 40 visits (65%), mostly noted either as estimated ranges (e.g. “150s/90s”) or a few individual readings. Only 3 out of 40 audited visits noted that the patient had taken ≥6 individual HBPM readings. Our survey of 19 clinicians revealed that 84% recommend HBPM, but 79% are unable to obtain adequate data for HBPM more than half the time. 79% reported they would use an electronic medical record integrated tool to record HBPM if available. Our Ishikawa analysis revealed that lack of standardize workflow and lack of an integrated electronic health record to capture HBPM readings are key barriers to HBPM uptake. Conclusions: Our QI initiative revealed a paucity of HBPM integration into clinical care, despite clinician preference and recommendation for HBPM. Lack of an electronic tool that integrates HBPM readings efficiently with routine visits was identified as a modifiable barrier to HBPM uptake, therefore future work is focused on creating and evaluating such a tool.