Ability and accuracy of patient-performed blood pressure monitoring among pregnant women in urban Ghana.
Ability and accuracy of patient-performed blood pressure monitoring among pregnant women in urban Ghana.
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DOI：
10.1016/j.xagr.2023.100243
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发表时间：
2023-08
期刊：
影响因子：
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通讯作者：
Oppong, Samuel A
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作者：
Lawrence, Emma R;Beyuo, Titus K;Newman, Noah;Klutse, Makafui Aku;Asempa, Joshua Kafui;Pangori, Andrea;Moyer, Cheryl A;Lori, Jody R;Oppong, Samuel A
在包括加纳在内的低收入和中等收入国家，很少进行孕妇血压监测。家庭血压监测的临床功效依赖于怀孕患者能够独立地执行正确的步骤来定位和使用血压监测仪并实现准确的血压测量。本研究旨在（1）评估孕妇是否可以正确使用自动血压监测仪在简短培训前后检查血压，（2）确定孕妇使用自动监测仪测量的血压值是否与医疗保健提供者使用标准诊所监测仪测量的血压值相似。这是一项在加纳阿克拉三级医院Korle Bu教学医院进行的横断面研究。参与者是首次产前检查的成年孕妇。由2名加纳医生进行数据收集。收集人口统计学、产科史和既往病史信息。提供了关于正确使用血压监测仪的简短培训，包括口头脚本、注释照片和动手演示。使用9项检查表进行培训前和培训后评估，检查表包括自动血压监测仪的正确准备、位置和使用。根据修改后的英国高血压协会方案，进行了一系列4次血压测量，交替由供应商使用诊所监测仪进行，由患者使用个人使用的自动监测仪进行，并在妊娠期间进行验证。在176名参与者中，平均年龄为31.5岁（±5.6岁），130名（73.9%）为经产。关于社会经济特征，128人（72.7%）已婚，171人（97.2%）有公共保险，87人（49.7%）完成了≤9年的正规教育。关于临床血压问题，19例（10.9%）在既往妊娠中有高血压疾病史，6例（3.4%）有慢性高血压。在接受任何培训之前，21名参与者（12.1%）正确执行了所有9个步骤，以准备，定位和使用自动血压计。比较训练前和训练后的能力，每个步骤的正确表现和正确执行的平均步骤数（分别为6.1±1.8和9.0±0.2; P<0.001）以及正确执行所有9个步骤的比例（分别为12.1%和96.6%; P<0.001）在统计学上显著增加。医生测量的血压值与患者测量的血压值之间的平均差异为收缩压5.6±4.8 mm Hg，舒张压3.4±3.08 mm Hg，收缩压（102/176 [58.0%]）和舒张压（141/176 [80.1%]）的大多数差异均在5 mm Hg以内。经过简短的培训，加纳的孕妇证明，她们能够使用自动血压监测仪正确准确地测量血压。
Patient-performed blood pressure monitoring in pregnancy is rarely performed in low- and middle-income country settings, including Ghana. The clinical efficacy of home blood pressure monitoring relies on a pregnant patient being able to independently execute the correct steps to position and use a blood pressure monitor and to achieve accurate blood pressure measurements. This study aimed to (1) assess whether pregnant women can correctly use an automatic blood pressure monitor to check their blood pressure before and after a brief training and (2) determine whether blood pressure values measured by pregnant women using an automatic monitor are similar to values measured by a healthcare provider using a standard clinic monitor. This was a cross-sectional study conducted at the Korle Bu Teaching Hospital, a tertiary hospital in Accra, Ghana. Participants were adult pregnant women presenting for their first prenatal care visit. Data collection was performed by 2 Ghanaian physicians. Information on demographics, obstetrical history, and past medical history was collected. A brief training was provided on the correct use of the blood pressure monitor, including a verbal script, annotated photographs, and a hands-on demonstration. Pre- and posttraining assessments using a 9-item checklist of correct preparation, position, and use of an automatic blood pressure monitor were performed. Following a modified British Hypertension Society protocol, a series of 4 blood pressure measurements were taken, alternating between provider performed using a clinic monitor and patient performed using an automatic monitor intended for individual use and validated in pregnancy. Among 176 participants, the mean age was 31.5 years (±5.6), and 130 (73.9%) were multiparous. Regarding socioeconomic characteristics, 128 (72.7%) were married, 171 (97.2%) had public insurance, and 87 (49.7%) had completed ≤9 years of formal education. Regarding clinical blood pressure issues, 19 (10.9%) had a history of a hypertensive disorder in a previous pregnancy, and 6 (3.4%) had chronic hypertension. Before receiving any training, 21 participants (12.1%) performed all 9 steps correctly to prepare, position, and use the automatic blood pressure monitor. Comparing pretraining vs posttraining ability, statistically significant increases were seen in the correct performance of each step and the mean number of steps performed correctly (6.1±1.8 vs 9.0±0.2, respectively; P<.001) and proportion performing all 9 steps correctly (12.1% vs 96.6%, respectively; P<.001). The mean difference between doctor-performed and patient-performed blood pressure measurements was 5.6±4.8 mm Hg for systolic blood pressure values and 3.4±3.08 mm Hg for diastolic blood pressure values, with most differences within 5 mm Hg for both systolic blood pressure values (102/176 [58.0%]) and diastolic blood pressure values (141/176 [80.1%]). After a brief training, pregnant women in Ghana demonstrated that they are able to use an automatic blood pressure monitor to check their blood pressure correctly and accurately.