A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring: The EMBRACE Cluster Randomized Clinical Trial.
A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring: The EMBRACE Cluster Randomized Clinical Trial.
复制标题
一个多方面的实施策略，以增加门诊血压监测：EMBRACE集群随机临床试验。
DOI：
10.1001/jamanetworkopen.2023.34646
复制
发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Moise, Nathalie
中科院分区：
文献类型：
--
作者：
Kronish, Ian M.;Phillips, Erica;Alcantara, Carmela;Carter, Eileen;Schwartz, Joseph E.;Shimbo, Daichi;Serafini, Maria;Boyd, Rebekah;Chang, Melinda;Wang, Xiaohui;Razon, Dominic;Patel, Akash;Moise, Nathalie
根据美国高血压筛查指南，一种理论指导的多方面实施策略（包括获得动态血压（BP）监测服务）是否能有效增加诊室血压升高的初级保健患者的诊室外BP监测？在这项包括8个安全网实践和1186例诊室血压升高但未诊断为高血压的患者的随机分组试验中，实施策略适度增加了患者完成诊室外血压监测的时间。这些研究结果表明，有必要更密集的实施策略，以增加高血压筛查指南，建议高血压诊断前的办公室外血压监测的依从性。这项随机分组试验评估了行为理论指导的多方面实施策略对门诊血压升高但既往未诊断为高血压的初级保健患者进行门诊血压监测的有效性。很少有初级保健患者在诊断高血压之前完成指南推荐的门诊血压（BP）监测。评价行为理论指导下的多方面实施策略对新发高血压患者门诊血压监测（动态血压监测[ABPM]或家庭血压监测[HBPM]）的有效性。这项2组、前后分组随机试验在8个实践的初级保健网络中进行（4项干预实践，99名临床医生; 4项对照实践，55名临床医生）和1186名患者（857次干预; 329例对照），在2016年10月至2017年9月期间至少有1次诊室血压升高访视，且既往无高血压诊断（实施前阶段）或2018年4月至2019年3月（实施后阶段）。数据分析时间为2023年2月至7月。家庭护理（对照组）或多方面的实施策略，包括可访问的ABPM服务;电子健康记录（EHR）工具，以促进测试订购;临床医生教育，提醒和与门诊BP监测相关的反馈; HBPM护士培训;和患者信息讲义。主要结局是患者在合格访视后6个月内完成门诊BP监测。次要结局包括临床医生下令进行门诊血压监测。盲态评估者从EHR中提取结果。共纳入1186例患者（857例干预组; 329例对照组），平均（SD）年龄为54（16）岁; 808例（68%）为女性，549例（48%）为讲西班牙语的患者;在记录了人种和种族的患者中，123例（10%）为黑人或非裔美国人，368例（31%）为西班牙裔。在干预措施中，在实施前和实施后期间，完成门诊BP监测的访视百分比从0.6%（0%ABPM; 0.6%HBPM）增加到5.7%（3.7%ABPM; 2.0%HBPM）（P = 0.009）。在控制实践中，在相应时期内，完成门诊BP监测的访视百分比从5.4%（0% ABPM; 5.4% HBPM）变为4.3%（0% ABPM; 4.3% HBPM）（P = 0.94）。实施后与实施前干预与控制措施的门诊血压监测的相对风险比（RR）为10.5（95%CI，1.9-58.0; P = 0.01）。门诊血压监测的RR率为2.2（95%CI，0.8-6.3; P = 0.12）。这项研究发现，一个理论为依据的实施策略，包括获得ABPM适度增加门诊血压升高，但没有高血压诊断的患者的门诊血压监测。ClinicalTrials.gov标识符：NCT 03480217
Is a theory-informed multifaceted implementation strategy that includes access to an ambulatory blood pressure (BP) monitoring service effective at increasing out-of-office BP monitoring among primary care patients with elevated office BP in accordance with US hypertension screening guidelines? In this cluster randomized trial including 8 safety-net practices and 1186 patients with elevated office BP but no hypertension diagnosis, the implementation strategy modestly increased patient completion of out-of-office BP monitoring. These findings suggest that there is a need for more intensive implementation strategies for increasing adherence to hypertension screening guidelines that recommend out-of-office BP monitoring before hypertension diagnosis. This cluster randomized trial evaluates the effectiveness of a behavioral theory–informed, multifaceted implementation strategy on out-of-office blood pressure monitoring among primary care patients with elevated office BP but no prior diagnosis of hypertension. Few primary care patients complete guideline-recommended out-of-office blood pressure (BP) monitoring prior to having hypertension diagnosed. To evaluate the effectiveness of a behavioral theory–informed, multifaceted implementation strategy on out-of-office BP monitoring (ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) among patients with new hypertension. This 2-group, pre-post cluster randomized trial was conducted within a primary care network of 8 practices (4 intervention practices with 99 clinicians; 4 control practices with 55 clinicians) and 1186 patients (857 intervention; 329 control) with at least 1 visit with elevated office BP and no prior hypertension diagnosis between October 2016 and September 2017 (preimplementation period) or between April 2018 and March 2019 (postimplementation period). Data were analyzed from February to July 2023. Usual care (control group) or a multifaceted implementation strategy consisting of an accessible ABPM service; electronic health record (EHR) tools to facilitate test ordering; clinician education, reminders, and feedback relevant to out-of-office BP monitoring; nurse training on HBPM; and patient information handouts. The primary outcome was patient completion of out-of-office BP monitoring within 6 months of an eligible visit. Secondary outcomes included clinician ordering of out-of-office BP monitoring. Blinded assessors extracted outcomes from the EHR. A total of 1186 patients (857 intervention; 329 control) were included, with a mean (SD) age of 54 (16) years; 808 (68%) were female, and 549 (48%) were Spanish speaking; among those with race and ethnicity documented, 123 (10%) were Black or African American, and 368 (31%) were Hispanic. Among intervention practices, the percentage of visits resulting in completed out-of-office BP monitoring increased from 0.6% (0% ABPM; 0.6% HBPM) to 5.7% (3.7% ABPM; 2.0% HBPM) between the preimplementation and postimplementation periods (P = .009). Among control practices, the percentage of visits resulting in completed out-of-office BP monitoring changed from 5.4% (0% ABPM; 5.4% HBPM) to 4.3% (0% ABPM; 4.3% HBPM) during the corresponding period (P = .94). The ratio of relative risks (RRs) of out-of-office BP monitoring in the postimplementation vs preimplementation periods for intervention vs control practices was 10.5 (95% CI, 1.9-58.0; P = .01). The ratio of RRs of out-of-office BP monitoring being ordered was 2.2 (95% CI, 0.8-6.3; P = .12). This study found that a theory-informed implementation strategy that included access to ABPM modestly increased out-of-office BP monitoring among patients with elevated office BP but no hypertension diagnosis. ClinicalTrials.gov Identifier: NCT03480217
登录
查看更多内容
DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
影响因子：
39.2
作者：
Shimbo D;Abdalla M;Falzon L;Townsend RR;Muntner P
通讯作者：
Muntner P
影响因子：
7.2
作者：
Adams, G;Gulliford, MC;Campbell, MJ
通讯作者：
Campbell, MJ
影响因子：
7.2
作者：
Moise, Nathalie;Phillips, Erica;Kronish, Ian M.
通讯作者：
Kronish, Ian M.
影响因子：
168.9
作者：
Lovibond, Kate;Jowett, Sue;McManus, Richard J.
通讯作者：
McManus, Richard J.