Barriers to screening and intervention for ED patients at risk for undiagnosed or uncontrolled hypertension.
OBJECTIVE
We describe clinician-reported knowledge of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definitions of Stage I hypertension; perceived causes of elevated blood pressure; barriers to blood pressure re-assessment; risk of adverse events associated with the elevated blood pressure.


METHODS
Health care providers from five emergency departments completed a questionnaire assessing knowledge of blood pressure criteria for hypertension, perceived causes of elevated blood pressures, barriers to re-assessment, and perceived risk of an adverse event at one year in a patient within three defined systolic and diastolic blood pressure ranges. Descriptive statistics were used to analyze the data.


RESULTS
Seventy-two percent (379/524) of providers (68 attending physicians, 87 residents, 209 nurses, and 15 nurse practitioners) completed questionnaires. One hundred and four providers (27%) correctly listed the systolic and diastolic criteria for Stage 1 hypertension. Nurses and physicians rated uncontrolled, known hypertension [mean (standard deviation)] [8.7 (2.1), 8.9 (1.9)] the highest and pain [8.3 (2.3), 8.3 (2.1)] as the second highest cause of elevated BP. Nurses and physicians rated the lack of time to perform a reassessment [5.2 (3.4), 4.7 (2.8)] and a lack of adequate staffing [4.7 (3.4), 4.6 (2.9)] the highest as barriers to re-assessment. Nurses' mean adverse risk assessment twice that of physicians.


CONCLUSIONS
Twenty seven percent of providers were aware of the JNC7 criteria and often attributed elevated blood pressures to chronic, uncontrolled hypertension, pain or anxiety. No single barrier to repeating elevated blood pressures was identified.
Department of Emergency Medicine and the Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. ptanabe2@nmff.org
Paula
P
Tanabe
David M
DM
Cline
John J
JJ
Cienki
Darcy
D
Egging
Jill F
JF
Lehrmann
Brigitte M
BM
Baumann
D001291:Attitude of Health Personnel; D015984:Causality; D016009:Chi-Square Distribution; D057210:Delayed Diagnosis / Q000451:nursing / Q000706:statistics & numerical data; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education / Q000458:organization & administration; D016529:Emergency Nursing / Q000193:education / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011446:Prospective Studies; D011795:Surveys and Questionnaires