- Email: [email protected]
Flip the clinic: implementing patient self-measurement of blood pressure using a kiosk in a clinic waiting room
Abstracts / Journal of the American Society of Hypertension 10(4S) (2016) e19–e38 Methods: This observational and cross-sectional study evaluated systolic, diastolic, mean and pulse pressures, along with heart rate, in 69 non-diabetic elderly patients. Ambulatory BP monitoring was used for pressure and heart rate measurements. Three periods were selected: preprandial (two hours before lunch), postprandial (2 hours after lunch) and sleeping (8 hours). Each period was subdivided into six intervals with their respective means. BP variability rates and heart rate were evaluated according to the studied periods and were calculated using the time-rate index. Results: Comparison of the means and BP variability between the preprandial, postprandial and sleeping periods revealed significant differences. For postprandial and sleeping systolic BP, the variations observed were 113.215.3 mmHg and 108.513.9 mmHg, respectively, P ¼0.003. The same significant variations were observed with the other pressures studied (P <0.001), except for pulse pressure. Associations between the postprandial and sleeping period variability rates were obtained for systolic BP (r ¼0.27; P ¼0.034; 95% CI: 0.059-0.132), diastolic BP (r ¼0.35; P ¼0.005; 95% CI: 0.050-0.112), mean arterial pressure (r ¼0.46; P <0.001, 95% CI: 0.048-0.110), pulse pressure (r ¼0.20; P ¼0.128; 95% CI: 0.041-0.080) and heart rate (r ¼0.02; P ¼0.855; 95% CI: 0.023-0.046). Conclusions: Postprandial BP variation had a positive and significant correlation with sleeping BP variation. The presence of this association may become a complementary marker of future cardiovascular events. Other studies are needed to confirm this hypothesis. Keywords: Postprandial hypotension; Ambulatory blood pressure monitoring; Elderly; Nocturnal blood pressure
P-16 High 24-hour systolic blood pressure values are associated with the development of paroxysmal atrial fibrillation episodes in hypertensive subjects - a preliminary report Charalampia V. Geladari,2 Emmanuel A. Andreadis,2 George N. Kolyvas,2 Anna I. Georgantoni,2 Elpida N. Pantikidi,2 Nikolaos D. Karamichalakis,2 Serafim E. Liapis,2 Angelopoulos T. Epaminondas.1 1Evangelismos General Hospital, Athens, Greece; 2Evangelismos Hospital, Athens, Greece Background: Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD). Atrial fibrillation (AF) is the most common sustained arrhythmia. It has been showed that these conditions commonly coexist, further increasing global cardiovascular risk. Objective: To investigate the association between systolic and diastolic blood pressure (BP) values, assessed by ambulatory blood pressure (ABP) monitoring, with the development of paroxysmal AF (PAF) in hypertensives. Design and Method: Subjects with office BP>/¼140/90 mmHg, with or without antihypertensive treatment were included. Exclusion criteria were severe renal, cardiac or other systemic disease, stable arrhythmia, including AF, and evidence of secondary HTN. A complete medical history, was obtained from all participants. ABP and Office (Microlife WatchBP O3, Microlife, Widnau, Switzerland) measurements were taken on the same non-dominant arm. ABP was monitored on a routine working day using validated oscillometric arm devices with AF detection (MicrolifeÒ WatchBPÒ O3 Afib, 24-hour blood pressure monitor with atrial fibrillation (Afib) detector). Daytime and nighttime periods were defined according to the patients’ diaries (awake and asleep periods). Heart rhythm recordings were performed using Holter Electrocardiogram (ECG) device (SpiderViewT ELA Medical, France) in order to establish the diagnosis of AF. Results are expressed as mean values +/- SD. Results: A total of 40 hypertensive individuals 60+/-14 years, 22 men, were studied. Three patients were excluded due to poor quality readings. On the basis of ABP monitoring, 14 subjects (38%) were classified as non-dippers. Patients who developed episodes of PAF had significantly higher 24-hour average systolic BP (136+/-7 vs 123+/-11 mmHg, p¼0.015), daytime average SBP (136+/-4 vs 126+4 mmHg, p¼0.04) and nighttime average SBP (134+/-8 vs 115+/-14 mmHg, p¼0.05) than those
e25
who did not develop PAF. In contrast, there was no significant statistical difference between diastolic BP (DBP) readings and PAF occurrence. Interestingly, a similar tendency between SBP levels (24-hour average, daytime average, and nighttime average) and the development of PAF was observed in the subgroup of patients labeled as resistant hypertensives. Conclusions: We demonstrate that higher SBP levels, assessed by 24-hour ABPM, may represent a reliable predictor for the development of AF in hypertensive individuals with or without antihypertensive medications. This points towards the potential harmful role that higher SBP levels hold in augmenting global cardiovascular risk for individual patients. Keywords: Arterial Hypertension; Atrial Fibrillation; Blood Pressure Monitoring; Systolic Blood Pressure P-17 Flip the clinic: implementing patient self-measurement of blood pressure using a kiosk in a clinic waiting room Beverly Green,1 Chung Chia-Fang,2 Laura-Mae Baldwin,3 Mathew J. Thompson,3 Sean A. Munson.2 1Group Health Research Institute, Bainbridge Island, WA, United States; 2University of Washington, Seattle, WA, United States; 3University of Washington School of Medicine, Seattle, WA, United States Objective: Asking patients to measure their own vital signs using a selfservice validated blood pressure (BP) kiosk in clinic has the potential to increase patient awareness of their BP control, and free up medical assistant (MA) time for other activities. To evaluate BP kiosk acceptability, usability, and impact on workflow of patient BP self-measurement in a primary care clinic waiting room. Methods: A primary care clinic in eastern Washington state placed 2 validated BP kiosks in the waiting room. Patients were asked to take their own BP and print out the results at the start of their clinic visit. Mixed method assessments included early (2-month) and later (8-month) qualitative and quantitative descriptive assessments of kiosk implementation via meetings with clinic leaders, focus groups with clinic staff and providers, observations of kiosk users, and in-clinic surveys of adult kiosk users. Results: Of the roughly 400 BPs/week on the kiosk 34% were stage 1 hypertension, 13% stage 2 or higher. Patient surveys revealed that most patients were comfortable using the BP kiosk (82% at 2 months and 87% at 8 months) and most thought it was accurate or more accurate than medical assistant measurements (81% at both time points). Initial provider concerns included accuracy, but most were confident after a discussion with the study team and use comparing it to other monitors. Patients and providers saw many benefits: easier BP rechecks at the same and follow-up visits, increased patient engagement, and savings of MA time (1 minute 30 seconds per visit) allowing them to do other tasks. The clinic addressed early concerns such as infection (sanitary wipes), instructions (simplification), and lack of personal touch (stationing a receptionist in the waiting room). Most patients (86%) were in favor of the clinic continuing to use the BP kiosks. Remaining challenges include kiosk privacy (possibly moving one kiosk to the exam room area) and accommodating differently sized and able patients. Conclusions: Providers, staff, and patients adapted to use of a self-service kiosk, providing opportunities for deploying saved MA time for other patient care activities. The clinic decided to keep the self-service BP kiosk after the pilot period. Keywords: Blood Pressure; Kiosk; Primary Care; Technology P-18 The watch office BP device does not record the same pressure as the Omron 907 used by the SPRINT study Clarence E. Grim. High Blood Pressure Consulting, Stateline, NV, United States Until the dramatic ACCORD (A) and SPRINT (S) studies using the Omron 907 oscillometric device, most major NIH sponsored BP drug studies
P-16 High 24-hour systolic blood pressure values are associated with the development of paroxysmal atrial fibrillation episodes in hypertensive subjects - a preliminary report Charalampia V. Geladari,2 Emmanuel A. Andreadis,2 George N. Kolyvas,2 Anna I. Georgantoni,2 Elpida N. Pantikidi,2 Nikolaos D. Karamichalakis,2 Serafim E. Liapis,2 Angelopoulos T. Epaminondas.1 1Evangelismos General Hospital, Athens, Greece; 2Evangelismos Hospital, Athens, Greece Background: Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD). Atrial fibrillation (AF) is the most common sustained arrhythmia. It has been showed that these conditions commonly coexist, further increasing global cardiovascular risk. Objective: To investigate the association between systolic and diastolic blood pressure (BP) values, assessed by ambulatory blood pressure (ABP) monitoring, with the development of paroxysmal AF (PAF) in hypertensives. Design and Method: Subjects with office BP>/¼140/90 mmHg, with or without antihypertensive treatment were included. Exclusion criteria were severe renal, cardiac or other systemic disease, stable arrhythmia, including AF, and evidence of secondary HTN. A complete medical history, was obtained from all participants. ABP and Office (Microlife WatchBP O3, Microlife, Widnau, Switzerland) measurements were taken on the same non-dominant arm. ABP was monitored on a routine working day using validated oscillometric arm devices with AF detection (MicrolifeÒ WatchBPÒ O3 Afib, 24-hour blood pressure monitor with atrial fibrillation (Afib) detector). Daytime and nighttime periods were defined according to the patients’ diaries (awake and asleep periods). Heart rhythm recordings were performed using Holter Electrocardiogram (ECG) device (SpiderViewT ELA Medical, France) in order to establish the diagnosis of AF. Results are expressed as mean values +/- SD. Results: A total of 40 hypertensive individuals 60+/-14 years, 22 men, were studied. Three patients were excluded due to poor quality readings. On the basis of ABP monitoring, 14 subjects (38%) were classified as non-dippers. Patients who developed episodes of PAF had significantly higher 24-hour average systolic BP (136+/-7 vs 123+/-11 mmHg, p¼0.015), daytime average SBP (136+/-4 vs 126+4 mmHg, p¼0.04) and nighttime average SBP (134+/-8 vs 115+/-14 mmHg, p¼0.05) than those
e25
who did not develop PAF. In contrast, there was no significant statistical difference between diastolic BP (DBP) readings and PAF occurrence. Interestingly, a similar tendency between SBP levels (24-hour average, daytime average, and nighttime average) and the development of PAF was observed in the subgroup of patients labeled as resistant hypertensives. Conclusions: We demonstrate that higher SBP levels, assessed by 24-hour ABPM, may represent a reliable predictor for the development of AF in hypertensive individuals with or without antihypertensive medications. This points towards the potential harmful role that higher SBP levels hold in augmenting global cardiovascular risk for individual patients. Keywords: Arterial Hypertension; Atrial Fibrillation; Blood Pressure Monitoring; Systolic Blood Pressure P-17 Flip the clinic: implementing patient self-measurement of blood pressure using a kiosk in a clinic waiting room Beverly Green,1 Chung Chia-Fang,2 Laura-Mae Baldwin,3 Mathew J. Thompson,3 Sean A. Munson.2 1Group Health Research Institute, Bainbridge Island, WA, United States; 2University of Washington, Seattle, WA, United States; 3University of Washington School of Medicine, Seattle, WA, United States Objective: Asking patients to measure their own vital signs using a selfservice validated blood pressure (BP) kiosk in clinic has the potential to increase patient awareness of their BP control, and free up medical assistant (MA) time for other activities. To evaluate BP kiosk acceptability, usability, and impact on workflow of patient BP self-measurement in a primary care clinic waiting room. Methods: A primary care clinic in eastern Washington state placed 2 validated BP kiosks in the waiting room. Patients were asked to take their own BP and print out the results at the start of their clinic visit. Mixed method assessments included early (2-month) and later (8-month) qualitative and quantitative descriptive assessments of kiosk implementation via meetings with clinic leaders, focus groups with clinic staff and providers, observations of kiosk users, and in-clinic surveys of adult kiosk users. Results: Of the roughly 400 BPs/week on the kiosk 34% were stage 1 hypertension, 13% stage 2 or higher. Patient surveys revealed that most patients were comfortable using the BP kiosk (82% at 2 months and 87% at 8 months) and most thought it was accurate or more accurate than medical assistant measurements (81% at both time points). Initial provider concerns included accuracy, but most were confident after a discussion with the study team and use comparing it to other monitors. Patients and providers saw many benefits: easier BP rechecks at the same and follow-up visits, increased patient engagement, and savings of MA time (1 minute 30 seconds per visit) allowing them to do other tasks. The clinic addressed early concerns such as infection (sanitary wipes), instructions (simplification), and lack of personal touch (stationing a receptionist in the waiting room). Most patients (86%) were in favor of the clinic continuing to use the BP kiosks. Remaining challenges include kiosk privacy (possibly moving one kiosk to the exam room area) and accommodating differently sized and able patients. Conclusions: Providers, staff, and patients adapted to use of a self-service kiosk, providing opportunities for deploying saved MA time for other patient care activities. The clinic decided to keep the self-service BP kiosk after the pilot period. Keywords: Blood Pressure; Kiosk; Primary Care; Technology P-18 The watch office BP device does not record the same pressure as the Omron 907 used by the SPRINT study Clarence E. Grim. High Blood Pressure Consulting, Stateline, NV, United States Until the dramatic ACCORD (A) and SPRINT (S) studies using the Omron 907 oscillometric device, most major NIH sponsored BP drug studies