Qualitative Analysis of Point of Care Ambulatory Blood Pressure Monitoring: Patient, Parent, and Primary Care Provider Perspectives

Abstract

Background: Hypertension is undiagnosed in three-quarters of affected youth. Barriers include uncertainty about the accuracy of in-office blood pressure measurements, limited access to recommended confirmatory ambulatory blood pressure monitoring (ABPM), and low subspecialist referral completion rates. This study aimed to assess whether 'point of care' ABPM, ABPM device placement within the primary care setting, could improve HTN diagnosis confirmation.

Methods: This prospective cohort study was conducted within a single urban primary care practice. 'Point of care' ABPM was offered to youth 10 to 17 years of age with suspected hypertension based upon a single manual blood pressure > 95th percentile. We conducted semi-structured qualitative interviews with patients, parents, and primary care providers to evaluate perceptions and experiences with 'point of care' ABPM, perceived barriers to device tolerability, confidence in results, and comfort with follow-up recommendations. Qualitative data were analyzed using an inductive thematic approach.

Results: 'Point of care' ABPM was offered to 62 youth and accepted by 60 (97%). Qualitative interviews of patients (N=25), parents (N=24), and providers (N=8) revealed that parents recognized the benefit and convenience of 'point of care' ABPM and trusted the ABPM results. Parents and providers reported greater certainty in the diagnosis when they did not have to rely on in-office blood pressure assessment alone.

Conclusions: ABPM may be an acceptable approach for improved hypertension diagnosis confirmation in children and adolescents when applied within the primary care setting. Further, it may help alleviate parent and provider uncertainty about the significance of elevated in-office blood pressure.

Keywords: ambulatory blood pressure monitoring; area deprivation; hypertension; point of care.