Implementing Self-Measured Blood Pressure in Primary Care: A Feasible and Systematic Approach.

Abstract

Randomized clinical trials and clinical practice guidelines recommend the use of self-measured blood pressure (SMBP) to help improve the treatment of patients with hypertension. Many clinicians use SMBP in their practices, but there is significant variability in how SMBP is implemented in their day-to-day practice. This quality improvement study details the pragmatic and real-world approach clinicians and administrators used at 3 sites of the IHA Medical Group, a part of Trinity Healthcare, to implement the American Medical Association (AMA) 7-Step SMBP framework as part of the larger AMA hypertension quality improvement program AMA MAP BP. The SMBP program included distributing SMBP devices, training patients on SMBP use, capturing and recording SMBP values in the electronic health record, using SMBP readings in treatment decisions, and receiving reimbursement for patient training and education. Of 331 patients enrolled, 98% of patients had at least 1 return visit within a year. Average systolic blood pressure was reduced by 8 mm Hg between the first and last office visit, and blood pressure control rates increased from 33.5% to 63.5% in these patients. Among patients with one return visit, 46% had documented SMBP readings and 71% were treated with medications. Payors reimbursed 95% of claims submitted for patient training.