Increasing the Uptake of the USPSTF Hypertension Screening Guidelines in Primary Care.

 描述(由申请人提供)：在办公室外使用动态血压监测(ABPM)测量血压时，大约五分之一的办公室血压升高患者的血压正常。这种情况被称为白大衣高血压，增加的心血管风险微乎其微，不需要抗高血压治疗。未能发现白大褂高血压会使患者面临BP药物不良反应的风险，并不必要地增加医疗成本。因此，美国预防服务工作组(USPSTF)最近发布了他们的高血压筛查指南更新草案，其中他们建议办公室血压升高的患者在诊断和治疗高血压之前进行动态血压监测。尽管有强有力的、一致的证据支持这一指南，但ABPM在美国很少使用。这项提议的目标是开发和测试一种干预措施，将增加USPSTF高血压筛查指南在不同初级保健环境中的接受度。我们将首先与初级保健患者和服务于弱势患者群体的大型门诊护理网络的提供者开展实施前重点小组，以增加对实施这一USPSTF指南的障碍和促进者的了解。接下来，我们将完善实施战略，包括1)增加对指南的了解的教育活动；2)计算机化的临床决策支持工具，当指南指示时，促进ABPM的订购；以及3)文化适应的、容易获得的ABPM服务。然后，我们将进行一项为期两年的整群随机临床试验，我们将网络中的8家初级保健诊所随机分为1)多方面指南实施干预组或2)等待名单对照组。在试验结束时，我们将评估干预措施在增加完成ABPM的指定患者比例方面的有效性。我们还将在实施后对患者和提供者进行重点小组调查，以评估干预措施是否可以在门诊护理网络内持续进行，并应传播到其他执业场所。

 DESCRIPTION (provided by applicant): Approximately one in five patients with elevated office blood pressure (BP) has normal BP when measured out of the office using ambulatory BP monitoring (ABPM). This condition, known as white-coat hypertension, confers minimal increased cardiovascular risk and does not require antihypertensive treatment. Failure to detect white-coat hypertension places patients at risk for adverse effects from BP medications and unnecessarily increases healthcare costs. Accordingly, the U.S. Preventive Services Task Force (USPSTF) recently published a draft update of their hypertension screening guideline in which they recommended that patients with elevated office BP undergo ABPM prior to being diagnosed with and treated for hypertension. Despite the strong, consistent evidence in support of this guideline, ABPM is infrequently used in the U.S. The goal of this proposal is to develop and test an intervention that will increase uptake of the USPSTF hypertension screening guidelines in diverse primary care settings. We will first conduct pre-implementation focus groups with primary care patients and providers from a large ambulatory care network that serves a vulnerable patient population to increase the understanding of the barriers and facilitators to implementing this USPSTF guideline. We will next refine an implementation strategy comprised of 1) educational activities that increase knowledge of the guidelines; 2) a computerized clinical decision support tool that facilitates ordering of ABPM when indicated by the guideline; and 3) a culturally-adapted, easily accessible ABPM service. We will then conduct a 2-year cluster randomized clinical trial in which we randomize 8 primary care clinics in the network to either 1) the multifaceted guideline implementation intervention or 2) a wait-list control group. At the end of the trial, we will assess the effectiveness of the intervention at increasing the proportion of indicated patients who complete ABPM. We will also conduct post-implementation focus groups of patients and providers to assess whether the intervention can be sustained within the ambulatory care network and should be disseminated to other practice settings.