Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000-2009
Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000-2009
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DOI：
10.1542/peds.2011-3888
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发表时间：
2012-10-01
期刊：
影响因子：
8
通讯作者：
Patel, Anisha I.
中科院分区：
文献类型：
--
作者：
Shapiro, Daniel J.;Hersh, Adam L.;Patel, Anisha I.
背景和目的：美国2%至5%的儿童患有高血压，在肥胖流行期间，高血压的患病率有所上升。对于3岁儿童的血压测量频率，专业组织并没有达成共识。这项研究的目的是估计美国儿科门诊期间高血压筛查的频率，并确定与门诊期间高血压筛查相关的患者和提供者层面的因素，特别是预防护理。方法：我们利用2000年至2009年全国门诊医疗调查和国家医院门诊医疗调查，分析了具有全国代表性的门诊就诊样本的数据。在涉及3至18岁患者的就诊子集中，我们估计了在所有就诊、预防性就诊和确诊超重/肥胖的预防性就诊期间进行筛查的频率。我们使用多变量Logistic回归来确定与筛查相关的患者和提供者层面的因素。结果：35%的门诊儿科就诊、67%的预防性就诊和84%被诊断为超重/肥胖的预防性就诊期间进行了高血压筛查。2000至2009年间，所有就诊和预防性就诊中的筛查频率有所增加。与筛查独立相关的因素包括高龄和超重/肥胖诊断。结论：在三分之二的儿科就诊和三分之一的儿科预防性就诊中，提供者没有测量血压。提供者可能理解在超重/肥胖儿童中进行筛查的重要性；但是，可能需要努力鼓励进行常规筛查，特别是在幼儿中。儿科2012；130：604-610
BACKGROUND AND OBJECTIVE: Hypertension occurs in 2% to 5% of children in the United States, and its prevalence has increased during the obesity epidemic. There is no consensus among professional organizations about how frequently blood pressure should be measured in children >3 years old. The purpose of this study was to estimate the frequency of hypertension screening during ambulatory pediatric visits in the United States and to determine patient-and provider-level factors associated with screening during visits specifically for preventive care.METHODS: We analyzed data from a nationally representative sample of ambulatory visits by using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2000 through 2009. In the subset of visits involving patients aged 3 to 18 years, we estimated the frequency of screening during all visits, preventive visits, and preventive visits in which overweight/obesity was diagnosed. We used multivariable logistic regression to identify patient-and provider-level factors associated with screening.RESULTS: Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed. Between 2000 and 2009, the frequency of screening increased in all visits and in preventive visits. Factors independently associated with screening included older age and overweight/obesity diagnosis.CONCLUSIONS: Providers do not measure blood pressure in two-thirds of pediatric visits and one-third of pediatric preventive visits. Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed. Pediatrics 2012; 130: 604-610