title: Self-Screening and Non-Physician Screening for Hypertension in Communities: A Systematic Review.
abstract: BACKGROUND
  Community-based self-screening may provide opportunities to increase detection of hypertension, and identify raised blood pressure (BP) in populations who do not access healthcare. This systematic review aimed to evaluate the effectiveness of non-physician screening and self-screening of BP in community settings.
  
  
  METHODS
  We searched the Cochrane Central Trials Register, Medline, Embase, CINAHL, and Science Citation Index & Conference Proceedings Citation Index-Science to November 2013 to identify studies reporting community-based self-screening or non-physician screening for hypertension in adults. Results were stratified by study site, screener, and the cut-off used to define high screening BP.
  
  
  RESULTS
  We included 73 studies, which described screening in 9 settings, with pharmacies (22%) and public areas/retail (15%) most commonly described. We found high levels of heterogeneity in all analyses, despite stratification. The highest proportions of eligible participants screened were achieved by mobile units (range 21%-88%) and pharmacies (range 40%-90%). Self-screeners had similar median rates of high BP detection (25%-35%) to participants in studies using other screeners. Few (16%) studies reported referral to primary care after screening. However, where participants were referred, a median of 44% (range 17%-100%) received a new hypertension diagnosis or antihypertensive medication.
  
  
  CONCLUSIONS
  Community-based non-physician or self-screening for raised BP can detect raised BP, which may lead to the identification of new cases of hypertension. However, current evidence is insufficient to recommend specific approaches or settings. Studies with good follow-up of patients to definitive diagnosis are needed.
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: Susannah
authors: S
authors: Fleming
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: Helen
authors: H
authors: Atherton
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: David
authors: D
authors: McCartney
authors: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK;
authors: James
authors: J
authors: Hodgkinson
authors: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK;
authors: Sheila
authors: S
authors: Greenfield
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: Frederick David Richard
authors: FD
authors: Hobbs
authors: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK;
authors: Jonathan
authors: J
authors: Mant
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: Richard J
authors: RJ
authors: McManus
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Family Medicine, University of Washington, Washington, Seattle, USA.
authors: Matthew
authors: M
authors: Thompson
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; alison.ward@phc.ox.ac.uk.
authors: Alison
authors: A
authors: Ward
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors: Carl
authors: C
authors: Heneghan
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000379:methods*; D059026:Diagnostic Self Evaluation; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008403:Mass Screening / Q000379:methods*
keywords: blood pressure; community health services; hypertension; primary care; screening; self-evaluation; self-screening.